Video: HIFU is FDA Approved, but Should You Get It? We ask Prostate Expert, Mark Scholz, MD
Ask a Prostate Expert | Transcription
Alex: Alright, well we're gonna get deep into the topic that I'm excited about because I think that this is a treatment that is being pushed very aggressively, and I don't think there's a lot of people really being clear on whether or not this is really the best option for patients. So, we're talking about HIFU, which is a huge topic. I see it all over the internet. I see tons of ads. If you even Google the word "HIFU" it's like six ads on Google on the first page. So, can you explain, is this really the hot new thing to do? I know it got, I think, FDA approved about three years ago.
Dr. Scholz: HIFU is another way to destroy prostate tissue, and if the prostate tissue is where the cancer is, it's an effective way to get rid of that tumor and to cure it. The problem with all prostate treatments—I mean, if you go back 15, 20 years, people were terrified of radiation treatments. What changed? Targeting changed. So, the capacity to deliver the radiation exactly where you want it and not spill over into the surrounding organs is what now makes radiation probably the preeminent treatment. So, HIFU is just getting started. We know that just like radiation or lasers or freezing, you can destroy prostate tissue. The question is, are the HIFU doctors that are using this technology fully experienced in targeting in the fashion that will get the job done without destroying the surrounding tissue. So, it's an attractive thing to do for some sort of focal treatment. Some of the doctors are using it to try and treat the whole prostate. The treatments that are directed at the whole prostate are going to have problems with erectile dysfunction just like surgery and radiation and the rest, so it's the patients that are going to be having focal treatment that might be able to benefit and have fewer side effects, but that requires even more accurate targeting.
So, my problem with HIFU has nothing to do with HIFU itself. My problem is that it's usually urologists who are using HIFU; not radiation therapists who are trained in targeting; not interventional radiologists who are also trained in targeting, but surgeons. And so, the surgeons get involved and there's going to be a long learning curve. Some of them, I predict, will never learn how to do it really well. So, that's always the big challenge in prostate cancer. It's not what you do; it's who you have do it.
Alex: That’s kind of funny. From a patient perspective—like the first time that I heard "high intensity focused ultrasound" I think like, "Oh, it's automatically going to be focused or it's automatically going to be focal and targeted," but I think that almost is kind of a mislabel. Like, I think that can lead people astray very easily. So, yeah, that's a really good point.
Dr. Scholz: Yeah, it does destroy the tissue where you point it, but it's not easy to see prostate cancer in the prostate. We use MRIs, we use ultrasounds, we use template biopsies, targeted biopsies, but knowing where the edge of the cancer is and exactly where it is located is quite difficult. I've been doing color doppler ultrasounds for 12, 13 years, and we can't always see precisely where the tumor is. When you can see it, then, of course, you have the challenge of getting your targeted treatment right on the spot, and then setting a good margin around it for safety (not going to far! because you're going to have more side effects). So, it takes the most skillful experienced doctors to do targeted therapy.
Alex: So, if a patient has been offered this as an option from their doctor and they go and talk to a urologist who is gonna do HIFU—Is there like—I know at the conference we've mentioned questions like, ask them how many procedures that they've done. Is that something that they should pay attention to and the patient can ask?
Dr. Scholz: Yeah, that's relevant. It's never easy, but I think that the online reviews are pretty good. If you have a long list of very happy patients that are putting five star reviews, that's a hopeful sign.
Alex: Okay, and what type of side effects can we expect from a standard HIFU treatment?
Dr. Scholz: Well, the main risk with most of these treatments is the development of erectile dysfunction, but you can have other complications, and the worst-case scenario, they create connections between the bladder and the prostate or the rectum and the prostate, which sometimes don't heal well. So, those issues can occur in less skilled doctors. They shouldn't occur with the highly skilled doctors.
Alex: And you currently don't have anyone that you've seen that has been able to use HIFU very effectively and treat patients without many side effects?
Dr. Scholz: Yeah, so I haven't found a maven that I trust and routinely send patients to. Another discouraging factor is many times this is not covered by insurance and it can be very expensive as well.
Alex: And have you seen patients come into your office who have had HIFU and are now needing subsequent treatment because it wasn't fully taken care of?
Dr. Scholz: Definitely—Not just HIFU. Patients that have had cryo or laser where the doctors try and do a focal treatment, but miss the target.
Alex: You know, it's interesting. It seems like we've done six or seven episodes of "Ask a Prostate Oncologist" and every single time the point has been made that you have to really research the doctor. You have to look at the reviews. You have to find somebody who's going to treat you well, and it's amazing to me how much I can Google this information, and I was talking to a patient on Monday and he's like, "Yeah, I didn't know that. Like, I didn't know that until somebody finally wrote an article on Google and I went to a support group and they said, “It's all about the doctor!'" You know, it's not just these treatments and not everybody's an expert and I think that we do have this overall sense of the medical community, you know, Oh it's a doctor! We trust them, and they know way more than I do. They've gone to medical school for 12, 16 years depending on their specialty, why would I know anything? And, so I think that, you know…
Dr. Scholz: The problem comes down to the very sensitive area that the prostate is located. If it was a gallbladder or an appendix or something like that: go to Kaiser, go to an HMO. A routine surgery done by a routine surgeon—an average surgeon—will almost certainly turn out fine. But the prostate is probably closer to something like brain surgery. The nerves are really complicated, there's not much space, there's a lot of blood vessels, and of course, when things don't go well, men lose their capacity for normal sexual function and that's a huge deal.
Alex: You've discussed radiation a little bit and the differences. So, would you—if you had a patient, you wouldn't be suggesting HIFU to them currently with all the other types of treatment that are out there?
Dr. Scholz: Yeah, the people talk about using these things as salvage treatments for people that had a radiation therapy that wasn't effective. Other things that are considered for salvage are, like, laser, cryotherapy. So, I—we've used a cryosurgeon who we've mentioned before, a guy named Dr. Duke Bahn in Ventura, California who has the skills. He's an interventional radiologist, and I'm sure there are others, but it is important to find that special person that has dedicated their whole life to doing this and then they're able to deliver and to give results that are acceptable and without a lot of collateral damage.
Alex: If you would like to have me ask Dr. Scholz a question in the future, you can go ahead and leave your questions in the comment below, and our team will pick them up. And, for more information about prostate cancer, if you would like to talk to somebody, we do have a Helpline, so you can go ahead and call us. And find our number on our website at PCRI.ORG. And, please if you like this video, you like the information, and you would like to see more of them give us a thumbs up on the video and subscribe to our Youtube channel, and this helps us share this type of prostate cancer information all around the world and we're very excited about that and so thank you so much. We appreciate your support and we hope you have a great week.