Is your doctor experienced with both prostate cancer and HIFU?

As with most medical treatments, HIFU is most effective when performed by an experienced physician.  A urologist who has extensive experience with prostate cancer and has dedicated himself to the application of HIFU in the treatment of this disease is best positioned to not only use HIFU as a treatment, but also to properly identify patients in which HIFU would be most effective.  These urologists are intimately familiar with all the conditions most critical to ensuring a successful outcome with HIFU.

 

Is your urologist certified by the American Board of Urology or the Royal College of Physicians and Surgeons of Canada? 

The American Board of Urology and the Royal College were created to act for the benefit of the public to insure high quality, safe, efficient, and ethical practice of urology by establishing and maintaining standards of certification for urologists.  They were organized to encourage study, improve standards, and promote competency in the practice of urology.  Applicants take written tests usually at the end of their residency followed eighteen months later by oral exams.  These certification exams determine a physician's proficiency in urology.  Almost all hospitals in the US and Canada require board certification in order to grant privileges to a doctor.  As a patient seeking medical services, you should ask your doctors whether they are board certified and have hospital privileges as this establishes basic minimum standards that physicians must meet.

 

What outcomes has your urologist obtained for HIFU patients?

Any man researching treatment options for prostate cancer is primarily seeking two things - a cure and minimal side effects.  It's easy for doctors to declare themselves experts or to tout their outstanding results, but it's vitally important to verify these claims.  The best way to do this in medicine is to study the scientific literature.  Peer reviewed articles allow other scholars in the author's specialty to critically assess the articles.  Scholarly journals only publish the articles that have undergone this review process.  This review helps ensure that solid scholarship has been applied to the study.  Be wary of claims that have not been through this process as they are subject to exaggeration or even outright fabrication. 

 

Do I need a biopsy in order to confirm a diagnosis of prostate cancer?

There has been an increase in the study of MRI to diagnose prostate cancer.  While many are hopeful that this method will eventually augment the ability to identify cancers which require treatment, a prostate biopsy is absolutely required not only to assure the existence of cancer but also to properly stage and grade the disease and determine if HIFU is a suitable treatment. 

Any urologist who suggests proceeding with HIFU or any other treatment for
prostate cancer without histological proof of the existence of cancer is doing so in direct violation of accepted urological standards.  MRI scans can produce false positives or false negatives.  Without a biopsy that confirms the existence of cancer, patients could be undergoing a completely unnecessary treatment and expense.

 

Is needle tracking a real risk for prostate biopsies or is talk of this phenomenon simply fear mongering?

Even though it may make intuitive sense that a needle biopsy of the prostate might spread cancer cells either in the bloodstream or in the needle track there is absolutely no scientific evidence in the published literature in the last twenty years to support this concept in prostate cancer.  It is simply wrong to advise against biopsy based on a false premise of possible cancer spread.

 

The Sonablate HIFU device has a few different technical features than the Ablatherm.  Would the Ablatherm device be improved with these features?

Power modulation, as advocated by Sonablate users, may result in insufficient heat generation to actually kill cancer cells where the power is reduced and thus lead to greater risk of persistence or recurrence of cancer.  The three power levels of the Ablatherm are scientifically based – the foundation of which is the thermal properties of the prostate which is different for the three situations (primary, repeat HIFU, and salvage (post radiation treatment).

Additionally, the outstanding image quality provided by the Ablatherm 7.5 MHz ultrasound imaging crystal makes add on modalities such as coronal imaging and Doppler, as used by Sonablate to map the neurovascular bundles, unnecessary in treatment planning or execution by Ablatherm.

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