Accounting for Operative Variables in HIFU For Localized Prostate Cancer

In an interview with CancerNetwork®, Mina Fam, MD, highlighted the precision of high-intensity focused ultrasound (HIFU) for localized prostate cancer, emphasizing the utility of robotic platforms and real-time MRI-ultrasound fusion. By delivering thermal energy in a stepwise, segmented fashion, clinicians can monitor intraoperative variables like prostatic edema, ensuring targeted ablation while sparing adjacent healthy structures. This adaptive approach allows for constant adjustments to protect the rectum and urethra, minimizing the risk of adverse effects.

However, the anatomic distortion and fibrosis resulting from focal therapy present unique challenges for salvage treatments. Fam noted that while salvage surgery or radiation remains feasible and safe, providers must navigate scarred tissue planes and distorted anatomy. For the multidisciplinary team, success in the relapsed setting requires an experienced, thoughtful approach to account for the altered tissue microenvironment. Ultimately, 3D mapping and real-time monitoring position HIFU as a refined tool, provided clinicians remain mindful of long-term anatomic considerations.

Fam is the medical director of Urologic Oncology at Jersey Shore University Medical Center and of Robotic Surgery at Ocean University Medical Center, as well as a urologic oncologist in the Hackensack Meridian Health system.

Transcript:

CancerNetwork: During the procedure, how does the technology account for intraoperative variables such as prostatic edema to ensure that the targeted thermal energy remains precisely on the tumor?

Fam: The technology we’re using is a robotic platform where you can make fine adjustments intraoperatively. But in terms of the planning stage, we use the MRI and re-fuse with the real-time ultrasound. We’re able to do a targeted map of our lesion in 3D. Then, we use the real-time ultrasound and deliver the treatments in a stepwise fashion, meaning the energy is delivered in segments. We’re also monitoring that real-time ultrasound to check for edema and any potential damage of surrounding structures, which we would want to avoid. We’re constantly adjusting during the treatment time to ensure that none of the healthy tissue we want to preserve are damaged [through] focusing on the target in real-time ultrasound.

In the event of a local recurrence, what technical considerations should radiation oncologists or surgeons be aware of regarding the tissue microenvironment of a previously ablated prostate when planning salvage therapy?

Focal therapy can cause a distortion of the anatomy. It does cause fibrosis and can cause the tissue planes for surgery to be much more different than someone who hasn’t had prior focal therapy. It’s important for the radiation oncologist to keep in mind how they plan their dosing for the urethra or near the rectum after a focal therapy case, and for a surgeon to be careful of fibrosis, scarring, and distorted planes. The good news is that salvage treatment is feasible, successful, and safe, but [we] obviously understand that [having] someone with more experience and a thoughtful approach to the treatment is important.