HIFU All Hype? Understanding This Non-FDA-Approved Prostate Cancer Treatment

Dr. David Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center, routinely encourages patients to explore all prostate cancer treatment options. Though he firmly believes in the success and benefits of robotic prostatectomy, he knows the decision for prostate cancer surgery does not come easy. “I want my patients to do their homework,” he says. “This is a life-saving decision that demands as much research as possible.”

With research, comes the daunting task of understanding the vast amount of information available. A quick Internet search for prostate cancer treatment yields hundreds of results. Treatment options and conflicting statistics abound. One such option is of particular concern to Dr. Samadi. HIFU (High Intensity Focused Ultrasound) uses a rectal probe to deliver sound waves directly to the cancer in the prostate gland. The ultrasonic beam heats and destroys the cancerous tissue, which is then naturally expelled from the body. Used in the treatment of localized prostate cancer, this technique was recently touted in UroToday as a good alternative for men who are not surgical candidates – those who are over 65 or are obese.

Patients conducting research on HIFU will find promising reports of outpatient surgery with minimal side effects

What’s troubling to Dr. Samadi is the way in which some prostate cancer physicians choose to promote the treatment option. “It’s funny,” said Dr. Samadi, “they seem to discourage robotic prostatectomy surgery by attacking the marketing surrounding it. Yet, the central message of some HIFU doctors is not results, it’s scare tactics and fancy vacations in Bermuda.”

Men with prostate cancer learn quickly that incontinence and impotence are two very daunting, potential side effects of treatment. The risk of negative impact on these two critical functions is possible with many of the treatment options. “Certainly the decision to have surgery should never be taken lightly,” Dr. Samadi said, “but to talk to a prostate cancer patient with words such as ‘limp and leaking’ or to suggest that their marriage will fall apart because they choose life-saving surgery is absurd. It shows a real lack of compassion.”

Dr. Samadi has been performing robotic radical prostatectomy procedures for the past ten years. He developed a unique approach, coined SMART (Samadi Modified Advanced Robotic Technique) that employs the da Vinci Surgical System.

What sets Dr. Samadi’s technique apart is a two-fold approach. First, he does not open the endopelvic fascia during surgery, allowing him to spare the tiny nerve bundles that control sexual function. Second, the dorsal vein complex is not sutured at the start of surgery, thereby reducing the risk of damage to the sphincter and allowing him to control the length of the urethra to increase the patient’s resistance to incontinence and leaking. Eighty-seven percent of Dr. Samadi’s patients regain sexual potency within 12 to 24 months and within only two to three months 97 percent regain urinary control.

Robotic prostatectomy surgery is proven, life-saving surgery

“Robotic prostatectomy surgery is proven, life-saving surgery,” stresses Dr. Samadi. “Beating prostate cancer isn’t about gambling with your life on an experimental procedure, with a tropical vacation thrown in.” HIFU is a very costly, non-FDA-approved treatment. Patients who choose to have the HIFU procedure must travel to another country and pay significant medical bills nearing $50,000.

Dr. Samadi believes that HIFU’s failure rate of 35% leaves many with little more than an exorbitantly priced vacation. Some physician web sites offer treatment options by locales such as Cancun, Bermuda and the Bahamas. “I’m not a travel agent, I’m a prostate cancer surgeon. And men don’t have to sacrifice urinary control or a happy sex life in order to live cancer-free,” adds Dr. Samadi.

“My patients are intelligent men making the most important decision of their lives. I know they’re capable of seeing beyond the clever marketing and hysteria of some web sites. As a medical community we should be educating patients about their options, not scaring them into a decision,” Dr. Samadi concluded.