What is HIFU and Sonablate HIFU?
Frequently asked Questions
What is the history of HIFU and how long has it been done?
Research on HIFU began in the 1950s at Indiana University (IU). In 1994, the first human prostate cancer study was done by Dr. Marberger and Dr. Madersbacher at the University of Vienna in Austria. In the study the Sonablate® 200 was used to treat 29 human prostates in vivo shortly before performing a radical prostatectomy. The goal was to investigate if the energy delivered was enough to destroy the desired tissue. The study found that treatment could be performed safely and could be repeated.
In 1995 a study done at Indiana University showed that the whole prostate could be treated without damaging the prostate capsule or the rectal wall. In 1999 Dr. Toyaki Uchida began treating patients using the Sonablate® 200. In 2001 Sonablate® 500 received the CE mark from Europe.
Currently there are nearly 100 Sonablate® 500 HIFU centres worldwide on six continents. There are over 150 physicians using the Sonablate® 500 worldwide and over 6,000 total procedures have been performed with the Sonablate® 500. Health Canada approved the Sonablate® 500 in June 2005 and the first Sonablate® HIFU procedures were performed in Toronto in March 2006.
Does HIFU only treat the cancerous cells or does it ablate the entire prostate?
HIFU treated the entire prostate by targeting tissue in six overlapping treatment zones. The tissue is heated rapidly in small lesion until eventually the entire prostate is ablated. By treating the entire prostate gland, the chance for recurrence, or the cancer coming back is minimized. All the organs and tissue outside of the prostate remain unaffected during HIFU.
Can HIFU be used to effectively treat only a small part of the prostate? FOCAL THERAPY?
The lesion that is created by HIFU is 3mm x 3mm x 12 mm high. This treatment lesion is created in 6 seconds and then the beam moves to another segment. In a 30 cc prostate that cycle can be repeated 2-4000 times. This will ablate the whole prostate.
We have seen that some men only have 2 or 3 biopsy cores that are positive for cancer. If these are all in the same area, then we may consider focal therapy. In the past we had seen in other treatments of prostate cancer that in 30% of the cases we find cancer in another area where the biopsy was negative or find areas of higher Gleason scores. Over the last few years we have seen that MRI (Magnetic Resonance Imaging) is quite specific and accurate in predicting the location of significant/suspicious prostate cancer as well as the local spread of prostate cancer.
Therefore, if a man had only a few cores positive and the MRI confirmed that there were no other areas of suspicion, then we can offer a focal, partial or hemi treatment to those areas only. The benefit is that it takes less time and the side effects are fewer with a faster recovery, sometimes not even requiring a catheter. The risk is that we may miss some cancer and a repeat treatment may be necessary, as well as the fact that the PSA will never go to zero, because we are intentionally leaving “normal” prostate untreated.
If the entire prostate is treated, does that include the urethra? What happens to the uretha? is it damaged?
The urethra consists of different anatomical segments. From the tip of the penis to the base of the bladder: the fossa navicularis, the pendulous urethra, the membranous urethra and the prostatic urethra. During HIFU, the entire prostate is ablated, including the prostatic urethra, as it can have cancerous cells in it. In doing so the end result is an empty cavity that acts like a conduit during normal urination. However, the urethra is derived from a different type of tissue (derived from the bladder squamous type epithelium) vs. prostatic tissue (glandular, fibrotic and muscular) and regenerates/re-epithelializes with time. The sphincter and bladder neck are the vital structures with respect to maintenance of urinary function NOT the urethra. These vital structures are not affected or harmed during HIFU.
Treatment & Travel:
If you would like to schedule treatment at Can-Am HIFU please call 1 -877-787-5906.
What information do you need from me prior to scheduling treatment?
Before you can be scheduled for treatment and to ensure you are a candidate for HIFU, we require the following information.
1. Biopsy Report and Gleason Score
2. Trans Rectal Ultrasound Report- indicating the size of the prostate as well as the dimensions (L x W x H).
3. PSA Report
If you are a candidate for HIFU and would like to proceed with the procedure, the Can-Am HIFU team will provide you with information regarding additional tests and blood work.
When is the next available treatment date?
For a list of the upcoming treatment weekends please call 1-877-787-5906.
How long do I have to stay in the treatment location?
It is recommended that patients who do not live in the Greater Toronto Area arrive into Toronto the day before their scheduled treatment day.
Patients may travel home the day after treatment; however, we suggest resting an additional day and travel home two days after your treatment. Travel preferences depend entirely on the individual and vary from patient to patient.
Is the Procedure covered by OHIP or other Provincial Health Plans?
Although the procedure is approved by Health Canada it is not covered under any provincial health plan. However, you may be able claim HIFU as a medical expense on your taxes; for more information visit www.cra-arc.gc.ca. Can-Am HIFU will provide a detailed receipt after the procedure for tax purposes.
Additionally, patients may finance all or a portion of their treatment through a financing organization called Creditmedical Corporation; visit www.creditmedical.com for more information.
Since the procedure is not yet approved by the FDA and is preformed outside the United States, US-based insurance companies and Medicare does not normally provide coverage for the treatment. However, several patients have been able to receive full reimbursement from their insurance company by filing a claim through an independent claims filing service; visit www.insuranceclaimsfiling.com for more information.
You may be able to deduct HIFU as a medical expense on your taxes. A detailed receipt will be provided after the procedure for tax purposes.
May I speak with a HIFU doctor or patient about the procedure and their experience?
Certainly, in fact we encourage it. Call 1-877-787-5906 to arrange a consultation with a HIFU physician or if you would like to speak with someone who has received HIFU treatment.