A new article about HIFU from the University of Miami is now out: Prospective Evaluation of Focal High-Intensity Focused Ultrasound (HIFU) for Patients with Localized Prostate Cancer.


Focal treatment, meaning treating only the area of the prostate which has been proven to contain cancer is a very attractive approach because there are fewer side effects than treating the entire prostate, which has been the general approach until recent new technology such as HIFU was introduced.  However, there is some controversy and disagreement about how to determine that the actual cancer is only in a certain area or areas, and how much of the prostate should be treated once this is established.  The results were very favorable with 83% of biopsies of the treated area negative for cancer at least 12 months. 13% of patients had cancer detected in an area outside the treatment area which does highlight the question above about how much prostate to treat.


Most patients are diagnosed with a standard 12 core office biopsy.  Some are diagnosed with biopsies directed at MRI abnormalities along with supplemental random biopsies in other areas.  The most definitive type biopsy is called a Transperineal Mapping Biopsy and is done under general anesthesia and dozens, as opposed to one dozen biopsies are taken. The number is proportional to the actual size of the prostate to make sure a FULL sampling and definite evaluation are done.  I can perform any of these three procedures depending on the patient’s condition and preference.  However, most focal treatment in such studies as the one above is NOT based on what I would call the gold standard of the Transperineal Mapping Biopsy.  If I use a focal approach I treat at a minimum the full lobe where the cancer was detected and require that BIOPSIES on the non-treated side AND MRI do not show any abnormalities.  Time and more experience and studies will help optimize treatment decisions and results going forward.  In the meantime, I will make sure my patients have a full understanding of the decisions we make together about their care and treatment plans.