Calls for Early Prostate Cancer Screening of Black Men

May Get a Boost from HIFU Technology

African American men who delay testing or treatment for prostate cancer run greater risks with their health than other males — because they are roughly 1.6 times more likely to develop the disease than white men, and also more than twice as likely to die from it as white men.

In light of those statistics, a recent study in Cancer, a peer-reviewed journal of the American Cancer Society (ACS) recommends that black men be screened for prostate cancer more often and at a younger age. The study is significant because it challenges the conventional wisdom that early screening of typically slow-growing prostate cancer can lead to over-treatment.

The recommendations of the ACS study may get a needed boost from a relatively new ultrasound procedure known as HIFU.

Brian J. Miles, MD

Brian J. Miles, MD

HIFU (which stands for High Intensity Focused Ultrasound) is a noninvasive procedure for ablating (removing) prostate tissue — minimizing the dreaded side effects of impotence and incontinence.  It works by directing high-frequency sound waves that heat up and burn off a target area within the prostate without damaging the structure of the prostate wall and attached nerve-endings. In 2015, the FDA cleared HIFU for prostate tissue ablation.

For the vast number of men diagnosed with localized prostate cancer (that has not metastasized), HIFU focal therapy may be a more appealing option than the choices these patients have had in the past.  In fact, according to the Urology Care Foundation, more than 90% of men who are told they have prostate cancer, have localized disease, meaning a majority of these patients could benefit from a minimally noninvasive procedure like HIFU.

Older African-American men could possibly benefit from HIFU. And younger African-American men who are susceptible to the disease may be willing to get tested earlier if they know they have the HIFU option, which may enable them to avoid the impotence or incontinence that can result from prostate surgery or radiotherapy.

In June 2018, the US Food and Drug Administration cleared a HIFU medical device called Focal One for prostate tissue ablation.  This next generation HIFU system is even more precise in targeting diseased tissue in the prostate.  Focal One fuses MR and 3D biopsy data with real-time ultrasound imaging, which allows urologists to draw very close margins around the targeted tissue and ablate an even smaller portion of the prostate. This lessens the damage to healthy tissue, and, again, minimizes the side effects of incontinence and impotence for patients.

Standard of Care and HIFU for Localized Prostate Cancer

For decades, doctors have offered prostate cancer patients two choices: radiation therapy or radical surgery to remove the entire prostate, which can cause life-altering side effects and compromise their quality of life.  More recently over the past decade, men with less aggressive disease have had the option to choose active surveillance.  But for some men, going to bed each night knowing they have cancer and it could progress won’t bring them peace of mind.

A study of 24 men who underwent the HIFU procedure was conducted at Houston Methodist Hospital and the procedure proved to be safe and effective, with oncologic control and undetectable PSA levels after a three month follow up.  This preliminary study data is a good indicator for urologists who want to offer a greater range of safe options to their patients.

In 2017, the US Centers for Medicare and Medicaid Services (CMS) recognized the HIFU procedure and created a specific billing code for partial reimbursement for Medicare patients who choose the HIFU option. And in March 2018, CIGNA became the first major private health insurer in the U.S. to cover HIFU as a salvage therapy for prostate cancer patients who failed radiation.

In Europe and around the world, HIFU has been used to treat more than 75,000 patients with encouraging results in terms of both survival rates and quality of life. For instance, a multicenter study conducted by the French Association of Urology (AFU) showed optimal preservation of continence for 97 percent of patients and erectile function for more than 78 percent of men.

As these European studies have shown so far, prostate tissue ablation with HIFU has achieved a good result with minimal side effects.

HIFU is a step in the right direction for patients who qualify for the procedure.

To learn more about prostate ablation and HIFU go to www.hifu-prostate.com.