Prostate cancer remains one of the most common cancers among men, with the American Cancer Society estimating nearly 300,000 new cases in the U.S. this year alone. While surgery and radiation have long been the standard treatments, a less invasive approach is steadily gaining traction: High-Intensity Focused Ultrasound, or HIFU. This advanced technology offers a promising middle ground – a targeted method that destroys cancerous tissue without incisions or radiation, and with fewer side effects. As more men seek treatments that not only fight cancer but also preserve quality of life, HIFU has emerged as a compelling option. “Cleveland Clinic Indian River Hospital is the only Cleveland Clinic hospital in Florida to offer HIFU treatment,” said Jamil Syed, MD, urologist at the Vero Beach hospital. “HIFU uses ultrasound – essentially sound waves – generated by a machine to heat and destroy specific areas of the prostate. The patient is under anesthesia, and we insert a probe into the rectum to visualize the prostate. Using a roadmap based on a biopsy performed beforehand, I can precisely target and destroy the cancerous tissue. It’s like using a magnifying glass to focus sunlight and burn a tiny spot on a leaf – that’s essentially what we’re doing.” Although HIFU has been used in Europe and Asia for decades, it only received FDA clearance in the U.S. in 2015 for the ablation of prostate tissue. The outpatient procedure is performed under spinal or general anesthesia and typically lasts between one and four hours, depending on tumor size and location. HIFU is minimally invasive, requires no incisions, and usually does not involve an overnight hospital stay. Most patients go home the same day, and recovery tends to be quicker and less painful compared to surgery or radiation. Unlike traditional treatments that affect the entire prostate, HIFU is often delivered as focal therapy, targeting only the tumor while sparing healthy surrounding tissue – much like a lumpectomy for breast cancer. A 2020 study in the Journal of Urology reported that over 90 percent of men treated with HIFU showed no signs of cancer progression after two years. Another study, published in European Urology, found that HIFU preserved urinary continence in over 95 percent of patients and sexual function in about 70 percent – significantly better outcomes than those usually associated with surgery or radiation. “Not everyone is a candidate for HIFU,” Dr. Syed cautioned. “We’re selective based on the type and location of the cancer. It’s best suited for localized prostate cancer – typically low- to intermediate-risk – and tumors confined to one area. If the cancer is spread throughout the prostate, we may recommend whole-gland treatment, such as complete prostate removal or radiation." The ideal HIFU candidate has a Gleason score of 7 or lower, with cancer that is localized and visible on imaging such as MRI. HIFU is also being used as a secondary treatment for men whose cancer has returned after radiation therapy. What truly sets HIFU apart is its potential to preserve quality of life. Traditional treatments like radical prostatectomy or radiation often come with significant side effects, including urinary incontinence, erectile dysfunction, and bowel issues. “HIFU really helps preserve urinary and sexual function post-operatively,” Dr. Syed said. “After a radical prostatectomy, almost all men experience some period of leaking urine and erectile dysfunction. With HIFU, only 10 to 20 percent experience significant issues like that – and that’s because we’re sparing one whole side of the prostate and avoiding nerve damage. That untouched side remains essentially normal.” Most patients are discharged the same day with a catheter in place for four to five nights. PSA levels are checked six weeks after the procedure and then monitored every three to four months for the first few years. An MRI is recommended one year after the procedure to confirm that the cancer has not returned. Even though only one side of the prostate may be treated, the entire gland is monitored for recurrence. Cryotherapy is another ablative therapy option. It uses extremely cold temperatures to freeze and kill cancer cells. Like HIFU, cryotherapy can be considered for low-risk, early-stage prostate cancer or as a salvage treatment after radiation failure. The American Cancer Society notes several other ablative therapies currently in development: <ul> <li>Transurethral Ultrasound Ablation (TULSA): Similar to HIFU, this technique uses ultrasound beams to heat and destroy prostate tissue, but the probe is inserted through the urethra rather than the rectum. MRI is used in real-time to guide the procedure.</li> <li>Focal Laser Ablation (FLA): A laser fiber is inserted into the prostate near the tumor under MRI guidance. Once in position, the laser is activated to heat and destroy cancerous tissue.</li> <li> Photodynamic Therapy (PDT): A light-sensitive drug is injected through an IV. A laser light source is then directed at the tumor using optical fibers, activating the drug and destroying surrounding blood vessels. This therapy is not yet approved in the U.S.</li> <li> Irreversible Electroporation (IRE): Electrodes are inserted around the tumor to deliver electrical pulses, creating holes in the cancer cell membranes, leading to cell death. Since this method doesn’t rely on heat or cold, it may be useful in protecting nearby critical structures.</li> </ul> “Prostate cancer treatment has become very personalized – it’s not one-size-fits-all,” Dr. Syed said. “What’s right for one man may not be right for another. The good news is, we’re seeing rapid advances in the field. Being informed helps patients ask the right questions and find the best treatment for their individual situation.” Jamil Syed, MD, is a urologist at Cleveland Clinic Indian River Hospital who specializes in the treatment of prostate cancer. He sees patients at the Rosner Family Health and Wellness Center, 3450 11th Court. Call 772-463-2010 for an appointment.