A Breakthrough in Prostate Cancer Treatment, and a Columbia Urologist Advocating Its Legalization

High intensity focused ultrasound, or HIFU, is being touted as a better alternative to radiation, chemotherapy or even freezing the prostate.

By David Greisman / December 15, 2010

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Cancer patients want their treatment to be effective, first and foremost. Of secondary concern – but still important – are the side effects.

A form of treatment for prostate cancer called high intensity focused ultrasound, or HIFU, is gaining traction as an alternate to chemotherapy, radiation or freezing the prostate.

HIFU uses ultrasound waves to treat prostate cancer. Doctors speak not only of its effectiveness, but also note that it leads less often to incontinence and erectile dysfunction.

And one of its proponents is a Columbia urologist, Dr. Kevin B. Blumenthal of Central Maryland Urology Associates, which is located near Howard County General Hospital.

Blumenthal spoke about HIFU on Tuesday at Howard County General Hospital.

"The waves are focused to a focal point, and at that point it creates energy up near 100 degrees Celsius, which kills the prostate cancer cells," Blumenthal said in an interview.

"It's similar to a magnifying glass burning a leaf. It's the same aspect with the ultrasound waves. Anything farther from the focal point is unharmed. But at the focal point, it creates the high energy that kills the cells."

The technology behind HIFU is not new, but it's only been used to treat prostate cancer for about the past two decades. HIFU has not yet been approved to treat prostate cancer in the United States, though clinical trials are ongoing.

"It's a paradigm changer," said Dr. Stephen Scionti, director of prostate cancer ablative surgery at New York University's Langone Medical Center in New York City.

"Medicine's very conservative. The field of urology is dominated by ideas that have been around for almost 100 years. The first operation to take the prostate out was described in 1904. That's 106 years ago. Now all of a sudden we said we could cure this disease without surgery, without radiation, using something like sound waves," Scionti said.

Scionti has used HIFU for more than five years to treat hundreds of patients. But beyond research, the actual practice of HIFU is done out of country, with both the patients and their doctors flying out.

"I've gone down to the Bahamas to get my patients treated," Blumenthal said. "They just opened a site in Bermuda, which is a little closer. A lot of people think that if it's not one in the United States, it's not good. That's not always the case. Other parts of the world have been doing this for a while. This has been done in Europe, in Asia and South America."

Nevertheless, Blumenthal not only travels to the Bahamas and Bermuda to be there with his patients, but also to learn the procedure.

"It helps to see a familiar face there before, during and after," he said.

HIFU is not without complications.

"There's no magic thing that you just do it and walk out and there's never an issue," Scionti said.

But the treatment leads to incontinence in just 1 percent of Scionti's patients, while 90 percent of his patients are still able to maintain erections, he said.

"One of the downsides is there's recovery involved," Scionti said. "We're destroying the prostate – of course there's recovery. There's a catheter involved. The tube has to drain the urine for the first couple of weeks. That's true with surgery as well. Anytime with a catheter, there's a risk of urinary infection.

"One can get scar tissue that forms in the prostate channel. It's not that common. That occurs in my patients less than 5 percent of the time," he said. "A rare complication, which thank god I've never seen, is something called a rectal fistula [damage to the rectal wall]. The risk of that is two or three out of 1,000, which is actually safer side by side than it is with surgery."

As the treatment has not yet been approved by the Food and Drug Administration, insurance does not cover the cost. Patients must instead pay themselves for HIFU.

Blumenthal stresses that HIFU does not cost as much as other treatments.

"It costs $25,000 to do, but it's actually a fair amount than surgery, which can range from $35,000 to $74,000, and radiation, which ranges from $40,000 to $100,000," Blumenthal said.

"From the standpoint of the insurance companies, once this is approved by the FDA in the United States, they would be much more willing to pay for this."

And that is one more reason why Blumenthal is speaking in favor of HIFU.

"You see these guys and the options that they have," Blumenthal said. "For the most part it's either surgery or radiation. You see the side effects they're left with. Often times they're not happy with the results.

"Patients want more. Doctors want more, too. Even though surgery and radiation are good, there's always room for improvement. This has the potential to be that."?