High Intensity Focused Ultrasound (HIFU)

Now patients have another option for treating prostate cancer besides radiation or surgery. HIFU is minimally invasive, and patients can go home the same day. The treatment is highly focused, sparing surrounding tissue and reducing the risk side of effects such as incontinence and erectile dysfunction.

What Is HIFU?

High Intensity Focused Ultrasound, or HIFU, is a minimally invasive procedure that targets cancerous tissue precisely through high frequency sound waves. An ultrasound probe is inserted into the rectum and the sound waves heat up and ablate the targeted tissue, killing just the cancer cells.

Mount Sinai is using robotic HIFU, in which high resolution images are fused with biopsy data and real-time ultrasound imaging. This allows the urologist to view cancerous tissue images in 3D.  With this clear view, the doctor can draw precise contours around the diseased tissue, and ablate only that portion of the prostate. This process, called focal therapy, minimizes damage to surrounding tissue, including nerves, blood vessels and muscle tissue. For patients, this reduces the risk of urinary incontinence and erectile dysfunction.

Focal therapy is similar to performing a lumpectomy to remove only the diseased tissue from the breast of a woman with breast cancer.  And the procedure still leaves the options of radical surgery or radiation therapy, should the cancer return.

HIFU Provides an Alternative

When a patient is diagnosed with prostate cancer that has not spread beyond the walls of the prostate, there are three ways to manage the cancer.  The first is watchful waiting or active surveillance. Often, prostate cancer grows slowly and is nonaggressive. The cancer may not impact the patient during his lifetime. Despite the slow progression of this disease, some patients are still uncomfortable with a diagnosis of cancer and prefer treatment.  The second option is complete surgical removal of the prostate, or radical prostatectomy. The third option is radiation therapy which requires multiple rounds of radiotherapy over several months.  Both surgical removal and radiation have been the standard of care for many years.

For men diagnosed with localized prostate cancer, HIFU provides another alternative. HIFU is a minimally invasive, outpatient procedure.  No incisions are made during treatment.  Think of holding a magnifying glass above a leaf on a sunny day.  The sun’s rays shine through the lens and cause the leaf to burn. The procedure is precise and effective.

Who Qualifies for HIFU?

Ideal candidates for HIFU are those who have early stage (Gleason 6 or 7), low-grade cancer that is confined to the prostate, and that is visible on an MRI or ultrasound. A PSA level below 20ng/mL is also preferred. HIFU is used to treat a single tumor or part of a large tumor and is not meant for those whose cancer has spread beyond the prostate.  If you are interested in HIFU, please contact the Mount Sinai Department of Urology at 212-241-9955.

Is HIFU Covered by Insurance?

HIFU is covered under Medicare, which has approved treatment reimbursement under a “C-code” for hospital outpatient department services and procedures. Coverage under private insurance varies, so contact your provider for more information. The American Medical Association has begun the process of establishing a CPT code for HIFU, which means that private insurers will be more likely to reimburse for the procedure, starting January 2021.