A New Nonsurgical Prostate Cancer Method Is Approved: HIFU

Looking particularly at figures from developed countries, prostate cancer is the most common cancer type. Patients' long survival has prompted a greater focus on treatment strategies in this field in recent years. Although surgery has always been the first option for early-stage prostate cancer treatment, this issue has generated serious debate.

Treatment methods such as open surgery, laparoscopic surgery and robotic surgery have been examined and their benefits assessed. Answers have been sought to many questions, including “Is there a nonsurgical treatment option for prostate cancer?” and “Can this disease be monitored without surgery?” Looking at the general nature of prostate cancer, we see that not all prostate cancers are the same.

In particular, the Gleason score, a scoring system reflecting the biology of this cancer type, is a test used to determine the course of prostate cancer. A low Gleason score indicates a more slowly progressing prostate cancer. A high Gleason score, on the other hand, means we are facing prostate cancer with aggressive biology. By considering the pattern of cancer spread within prostate tissue, the level of PSA (prostate-specific antigen) secreted and the Gleason grade, we can classify prostate cancer into 3 main risk groups: low risk, intermediate risk and high risk.

In low-risk groups, monitoring without treatment has long been discussed, but applying it to someone diagnosed with cancer is difficult. Particularly in very early, nonaggressive disease, the question remains: Are there nonsurgical treatment options? is a question that constantly comes to mind. Looking at developments over the last 10 years, two methods have emerged. One is cryoablation, which can be described as freezing treatment applied to prostate cancer through electrodes.

Another method is HIFU (high intensity focused ultrasound), which focuses high levels and intensities of ultrasound waves on prostate cancer tissue. This means ablation using high-intensity ultrasound technology. It is one of the regional ablative treatments debated and intensively researched in recent years. Compared with HIFU, cryoablation has come to the forefront in practical use, and its applications have been accepted by international authorities. HIFU destroys tumor tissue by transmitting ultrasound waves into the prostate tissue through a probe inserted into the rectum, without entering the prostate directly. This method has been investigated in recent years because of its ease and potential appeal to patients.

It was first tested in patients whose cancer recurred (relapsed) after radiotherapy, achieving pathological complete responses approaching % 60. These results offered encouragement and paved the way for its use immediately after prostate cancer diagnosis. Recent study results also show that HIFU may be effective in initial cancers.

Authorities now accept HIFU alongside cryoablation as a possible surgical alternative in low- and intermediate-risk patients, with prostate-confined disease and not excessively high PSA or Gleason scores. FDA-approved HIFU showed success over 5 years approaching % 80. These findings renewed interest and highlighted nonsurgical options in routine practice.