Edward Uchio, MD, FACS, Professor and Jerry D. Choate Chair in Urologic Oncology, Director of Clinical Research, Department of Urology at the University of California, Irvine talks about new system called Focal One that assists HIFU in treatment for patients with prostate cancer.
Interview conducted by Ivanhoe Broadcast News in May 2019.
You’ve come up with some new things for prostate cancer patients. What’s new?
UCHIO: Prostate cancer is very unique in that it grows very slowly and most patients don’t need treatment because they often die of other causes. But it is still considered a cancer, so in the past we were fairly aggressive with treatment, not truly understanding how the cancer would behave. We did what we call “radical” treatments. We would take out or radiate the whole prostate to treat the cancer. The techniques are different now, utilizing newer technologies such as robotic/laparoscopic systems for surgery and more advanced machines for radiation. But because we treat the whole prostate, we can get side effects which include problems with sexual function and urinary leakage. A new way of treating prostate cancer focuses on the cancer itself and not the rest of the normal prostate. Because this treatment is so precise, the patients have much less side effects as if we never treated the prostate at all. You have to understand the majority of prostate cancers should still be followed (i.e., active surveillance) and not warrant even this focal treatment. Other prostate cancers involve the whole prostate and behave aggressively and focal therapy would not be ideal in this setting also. But if the prostate cancer is diagnosed early and is found only in one location, this new treatment may be an option; especially when the patient is worried about the cancer and is not comfortable following the disease with active surveillance. Recently published data with intermediate follow-up at eight years, shows a very good treatment response with focal therapy using High-intensity focused ultrasound (HIFU).
Can you tell us about the treatment itself?
UCHIO: We now have newer ways of diagnosing prostate cancer; we can actually look inside the prostate using MRI or magnetic resonance imaging. In the past we weren’t able to see the cancer so we would randomly (blindly) put needles into the prostate, what we call systematic prostate biopsies. Now that we can see the cancers using MRI, we are able to place needles directly into the cancer using a robotic arm. This robotic MRI biopsy system is called the Artemis MRI-fusion biopsy device. By placing a needle directly into the cancer using a 3-D picture of the prostate, we are able to know exactly where the cancer is. This allows us to treat the cancer focally using focused ultrasound waves or HIFU. Since the cancer is only treated and not the whole prostate, the patient has very minimal side effects. However, patients must understand that this is a very new technology and because of this we don’t have results of long term (10-15 yrs.) studies like we have for surgery and radiation. This treatment is not for aggressive and high volume prostate cancers; it is for select patients. As a Urologic Oncologist, we want to be able to offer all the newer technologies and treatments for our patients. The device we recently acquired is called the Focal One. This Focal One HIFU system is the newest way of focally treating prostate cancer. It uses a technology involving high intensity focused ultrasound (HIFU), where you can actually focus ultrasound waves and heat up the tumor, killing only the cancer within the prostate. This advanced HIFU system is specifically built for focal therapy. It uses the data from the Artemis system described earlier, so you can actually treat the cancer in 3-D. Other HIFU systems were developed to treat the whole prostate unlike the Focal One.
Take us through the process from when you get a patient who’s got cancer in just one part of the prostate, then through the rest of the treatment process.
UCHIO: Once we know that the cancer is in a certain location by MRI, we can biopsy it using the Artemis system. We can then take the prostate biopsy tissue and make the diagnosis of cancer under the microscope and determine how aggressive it is (i.e., Gleason Score). At UCI, we also utilize advanced genomic testing of the cancer tissue to determine how it’s going to behave in the future. So as long as the patient is an appropriate candidate, we can treat the cancer with the Focal One system. The patient would come in for an outpatient procedure and would leave the same day after a few hours of treatment. With HIFU, we don’t place any needles into the prostate like we do with cryotherapy (freezing the prostate cancer), so it is by far the least invasive treatment. At home they can go back to their regular activities immediately. Some patients require catheters because the prostate may swell depending on the amount of treatment. This is only temporary and will be removed in a couple of days. Overall, they have very minimal side effects and pain; most feel like they did pre-treatment.
One-time treatment?
UCHIO: One-time treatment for most. But since we’re only treating part of the prostate, prostate cancer can develop on the other untreated side. The benefit of this HIFU technology is that it allows us to treat again if a new cancer develops or if there is a recurrence, still avoiding radical treatment of the prostate. This is unlike other treatments such as radiation therapy which also effects normal tissue to some degree which limits retreatment.
How long does the treatment take?
UCHIO: It really depends on size of tumor and the overall size of the prostate. But in general, the treatment usually takes less than a couple of hours and most of the time is spent regarding patient set-up. All of the patients go home the same day. And most will have a decent part of their day still left over even after treatment.
How about this patient? Can you talk about his case a little bit?
UCHIO: Mr. Nelson was an excellent candidate for focal HIFU therapy. He didn’t have aggressive prostate cancer and it was confined to only one side of his prostate. He was very uncomfortable following the prostate cancer, and it was just slightly more aggressive than the standard prostate cancers we follow (active surveillance). He wanted some form of treatment, but didn’t want radical treatment. Despite this, we always counsel the patient regarding standard of care therapies which would be surgery (robotic or open) or radiation therapy, because these newer focal treatments don’t have long follow-up. He actually searched us out because we are one of the few institutions that have this technology. And because his cancer was only in one location, we were able to treat it completely with this new Focal One device. We were able to focus the ultrasound energy just on the cancer and spare the normal prostate. He has been doing well after, he went home the same day. He’s due for standard follow-up soon. He has no side-effects from his treatment. Actually, he basically doesn’t even feel like he’s been treated, and that’s often the case with most of the patients treated with focal therapy. UCI Health was the first institution to treat prostate cancer with the Focal One HIFU device in the United States since it was approved.
What haven’t I asked you that you think we should include in the story if anything?
UCHIO: At UCI Health, we have all the latest technologies for the treatment of prostate cancer and were one of the pioneers in robotic surgery. We have been performing prostate cancer focal therapy for many years using technology such as cryotherapy and the first- generation HIFU devices. In fact, a very special friend of mine who I treated with HIFU helped me acquire the Focal One. He was very satisfied with his prostate cancer treatment and wanted to make sure we had the latest technology in HIFU to ensure that our patients received the best treatment. This is the newest machine available and was just recently FDA-approved. The company is based in Paris and with their support were able to treat the first patient in the United States.
How long ago was it FDA approved?
UCHIO: It was just approved in June of last year.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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