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High intensity focused ultrasound (HIFU) for prostate cancer (PCa)
The diagnosis More and more men suffer from prostate cancer (carcinoma of the prostate, prostate cancer). A cancerous growth is frequently discovered during an examination by a specialist or when treating a benign increase in the size of the prostate. A final determination regarding the diagnosis of cancer is obtained by means of the PSA level, additional diagnostics and, if required, taking tissue samples (biopsy). Lately it has also been possible to detect cancerous growth in the subclinical phase by isolating, counting and molecularly characterizing circulating tumor cells. You can find more information about this on the page => Biopsy-free diagnostics. An analysis of the proteomes in the urine (DiaPat) can verify an important indicator for prostate cancer. MR spectroscopy makes it possible to see the cancerous areas. It is possible to achieve touchless sealing of the tumor with HIFU therapy so that a spreading of the tumor cells is avoided. As a rule, unlike with radical surgery, incontinence or impotence do not occur. The US company Focus Surgery from Indianapolis, Indiana developed, in cooperation with the urologist Dr. Joachim-Ernst Deuster from Heidelberg, Germany, the Sonablate 500, a device that works with intense and bundled ultrasound in accordance with the HIFU (High Intensity Focused Ultrasound) principle. The Sonablate 500 is produced at Misonix Inc. in Farmingdale, New York.
	A comprehensive consultation regarding possible risks is conducted before every treatment.
Treatment The patient is initially given a mild general anesthetic, which is combined with local anesthesia near the prostate. This type of anesthesia was specifically developed for this by a renowned anesthesiologist from the Clinic for Prostate Therapy in Heidelberg for the HIFU procedure. The patient is in a kind of deep sleep and does not have to deal with the consequences of full anesthesia. The treatment itself is carried out in the lithotomy position (dorsal position) with legs slightly bent so that the treatment probe can be inserted through the rectum and introduced into the prostate. In most cases, this approach presents no problems whatsoever. The HIFU principle A transducer head is inserted into the rectum. It has two functions. It creates an ultrasound picture of the prostate on the one hand, while on the other it captures and calculates the area that must be irradiated. To be on the safe side the entire prostate is usually treated. By using the ultrasound analysis, it is largely possible to avoid injury to the surrounding tissue and other organs. During the treatment, a computer determines the correct area to be treated in three dimensions and marks it on the ultrasound picture. The transducer head then emits ultrasounds with a frequency of four megahertz (MHz). The sound waves are bundled, just like they would be in a concave mirror, into a focal point that is about three to four centimeters away.
	The schematic drawing explains how the high-intensity ultrasound functions: the ultrasound (blue green) is radiated from the transducer head so that it concentrates in the focal point and causes the desired heat effect there (red area). The area to be irradiated with ultrasound is exactly calculated with the help of ultrasound images and computers.
An alternative transducer head makes it possible to go down to a depth of 2.5 or 5 centimeters. The heat developed there is between 90° to 100° C, while the tissue through which the radiation has to travel is almost not heated, let alone injured. The prostate or cancer tissue is destroyed in the focal point of the ultrasound; the rest of this coagulation is taken care of by the body itself. After each shot, the ultrasound focal point is guided through the diseased tissue, millimeter by millimeter, with the physician monitoring the success of the treatment online using the ultrasound image on the computer. With new software, which has been utilized in Heidelberg since 2007, the transducer head can capture an even larger prostate area, reduce the shot sequence of the pulsed ultrasounds and reduce the treatment time overall. Depending on the size of the prostate, the treatment takes between two and five hours.
Do you have additional questions about HIFU? > You can find more information and videos about the treatment process here > This will link you to the PCa-/HIFU guide > You can contact us here

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