Dr Avais Syed
Hearing the words “prostate cancer” is frightening, and for many men the worry extends to what treatment might cost them: bladder control and sexual function. For some early cancers, a newer option treats the tumor with no incisions at all. It is called HIFU.
What is prostate cancer?
The prostate is a small, walnut-sized gland located below the urinary bladder in men. It produces fluid that forms part of semen. Prostate cancer develops when cells in the prostate begin to grow uncontrollably. It is one of the most common cancers among men, particularly older men. While some prostate cancers grow slowly and may not require immediate treatment, others can be aggressive and spread to other parts of the body. Early diagnosis and assessment of the cancer’s stage and risk category are important in deciding the most appropriate treatment.
Treatment options at a glance
Treatment depends on how aggressive the cancer is and whether it has spread. Slow-growing cancers may only be monitored (active surveillance). Surgery removes the whole prostate, radiotherapy destroys cancer cells with radiation, and hormone therapy is mainly for advanced disease. All are proven, but surgery and radiation can affect urinary, bowel and sexual function.
What is HIFU?
High-Intensity Focused Ultrasound (HIFU) destroys cancer with sound energy instead of a blade or radiation. A slim probe placed through the rectum directs focused beams that heat targeted tissue to roughly 80 to 90°C, destroying cancer cells while sparing the tissue the beams pass through. There are no incisions or cuts, and no radiation. The patient is discharged in a day.
Focal one: Robotic precision
Focal One is a robotic-assisted HIFU system. It fuses MRI scans with live ultrasound images, so the specialist can map the cancer in three dimensions and the robotic arm delivers energy exactly where it is needed. Treatment can be focal, aimed only at the confirmed tumor, or cover the whole gland when required.
Who is it for?
HIFU is generally considered for localized prostate cancer, meaning cancer that has not spread beyond the prostate, most often low- to intermediate-risk disease confirmed by MRI and biopsy.
It is not suited to everyone and a specialist assessment is essential.
A day-care procedure
HIFU is usually a day-care procedure. Treatment takes one to three hours under anesthesia, and most men go home the same day. A urinary catheter is commonly needed for a few days to a couple of weeks. With no wounds to heal, many men return to normal activities quickly, though recovery varies.
Benefits and risks
The main appeal is protecting quality of life. Because HIFU targets the cancer without cutting, it is designed to spare the urinary sphincter and the nerves that control erections. Compared with radical surgery and radiation therapy, it generally carries a lower risk of long-term incontinence, and with focal treatment many men keep erectile function. Treatment can often be repeated and does not rule out surgery or radiation later.
Follow-up with PSA tests, MRI and sometimes repeat biopsy is important.
Robotic-assisted HIFU offers a minimally invasive, day-care option for carefully selected men who want to treat their prostate cancer while protecting urinary control and sexual function. Discuss all options, including active surveillance, surgery, radiation and focal therapies, with your specialist.
(The author is Principal Consultant Urology, Renal Transplant, Robotics & Uro-Oncology, Max Super Speciality Hospital, Saket, Delhi.)
