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Experimental Treatments for Prostate Cancer

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Well there are really two experimental or emerging treatments for prostate cancer and the first is High Intensity Focused Ultrasound or HIFU and the second is Cryotherapy.

There are two HIFU machines, the Ablatherm and the Sonablate.

The Ablatherm has been used fairly extensively in Europe with the Sonablate mainly used in Japan.1
I was fortunate to go to Japan and learn from the world leader regarding the Sonablate.

Although there’s been a lot of cases done worldwide there are some concerns about the long term results of these treatments and we’re still awaiting 10 to 15 year data on the success of HIFU in the management of prostate cancer.2

So essentially what is involved with HIFU treatment is we have a probe in the back passage, we scan the prostate, you have soundwaves that go through and treat the prostate and heat the prostate so the cancer cells die.3

The advantage of this treatment is that it is repeatable2, you can do it again, it’s usually an outpatient treatment or an overnight treatment.

Sometimes we compile it with a prostate resection to allow patients to pass urine better.

There is a fairly high erectile dysfunction rate with it4 and the concern is that we don’t have long term data on it but it’s a treatment that can be offered to patients particularly if they’re not suitable for surgery or radiotherapy.5

The second type of emerging treatment or experimental treatment which is cryotherapy which is freezing the prostate.

This is only really done in about three centres in the United States.

Its main use maybe in patients that have radiotherapy and failed treatment.6

There’s a significant erectile dysfunction rate6 and we are, we do have concerns about cure, the cure rate with cryotherapy.

So really it’s really not used very much in Australia and could be classified as experimental treatment at this stage but I think within a clinic trial, both the HIFU and cryotherapy is reasonable to consider.

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Experimental Treatments for Prostate Cancer

Two emerging, still-experimental treatments for prostate cancer are High Intensity Focused Ultrasound (HIFU) and cryotherapy.

High Intensity Focused Ultrasound (HIFU)

HIFU uses focused soundwaves, delivered through a probe placed in the rectum, to heat prostate tissue so that cancer cells die.3 Two main HIFU machines exist - the Ablatherm (used extensively in Europe) and the Sonablate (used mainly in Japan).1 Dr Kooner had the opportunity to travel to Japan and learn the Sonablate technique from the world leader in the field.

Advantages:

  • Repeatable - the treatment can be delivered again if needed.2
  • Usually an outpatient or overnight procedure.
  • Sometimes combined with a prostate resection so the patient can pass urine more easily afterwards.

Concerns:

  • Relatively high rate of erectile dysfunction.4
  • Long-term (10–15 year) outcome data are still being awaited.2

HIFU is a reasonable option for selected patients - particularly those who are not suitable for surgery or radiotherapy.5

Cryotherapy

Cryotherapy freezes the prostate to destroy cancer cells. It is only performed in around three centres in the United States. Its main role is for patients whose cancer has recurred after radiotherapy.6

Concerns include a significant rate of erectile dysfunction6 and uncertainty about long-term cure rates. Cryotherapy is not used much in Australia and is still best considered experimental at this stage.

Summary

Both HIFU and cryotherapy are reasonable to consider within a clinical trial, but longer-term data are still needed before they can be recommended as standard treatments.

References
  1. The clinical applications of high intensity focused ultrasound in the prostate - Rowland Illing and Alexander Chapman - International Journal of Hyperthermia, 23(2), 183–191 - https://doi.org/10.1080/02656730601173037
  2. High-intensity focused ultrasound with visually directed power adjustment for focal treatment of localized prostate cancer: systematic review and meta-analysis - Samuel J. Peretsman, Mark Emberton, Neil Fleshner, et al. - World J Urol 42, 175 (2024) - https://doi.org/10.1007/s00345-024-04840-6
  3. What is HIFU - Cancer Research UK - https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/high-intensity-focal-ultrasound-hifu
  4. Risk Factors for Severe Erectile Dysfunction after Focal Therapy with High-Intensity Focused Ultrasound for Prostate Cancer - Sunao Shoji, Satoshi Kuroda, Kohei Uemura, et al. - Biomedicines. 2022 Nov; 10(11): 2876 - doi: 10.3390/biomedicines10112876 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9687416/
  5. High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment - Mohammed Alkhorayef, Mustafa Z. Mahmoud, Khalid S. Alzimami, et al - Pol J Radiol. 2015; 80: 131–141 - doi: 10.12659/PJR.892341
  6. Cryotherapy for Primary Treatment of Prostate Cancer: Intermediate Term Results of a Prospective Study from a Single Institution - S. Alvarez Rodríguez, F. Arias Fúnez, C. Bueno Bravo, et al. - Prostate Cancer. 2014; 2014: 571576 - doi: 10.1155/2014/571576 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945790/