Scott Webb (Host): Prostate cancer is the most common malignancy other than skin cancer diagnosed in American men. There are several successful treatment options available for prostate cancer. But today, we're discussing the high-intensity focused ultrasound, HIFU, with Dr. Marco Salazar from EvergreenHealth Urology Care.

Hello and welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb. Dr. Salazar, thanks so much for joining me today.

Dr. Marco Salazar: It's a pleasure to be here.

Host: This is going to be a great topic. I can't wait to get started here. So, let's just have some background. What is high-intensity focused ultrasound?

Dr. Marco Salazar: So, it is a relatively new technique, at least in the United States, of minimally invasive of treating prostate cancer. Traditionally, when someone has prostate cancer and it requires treatment, you undergo either surgery or radiation, which treats the entire prostate. Now, in men who have extensive disease, meaning that it involves multiple parts of their prostate, that would be the intervention of choice. But in men who have a certain type of prostate cancer, specifically Gleason 3+4 or grade group 2, these men are candidate for this particular treatment modality. The treatment, at least at EvergreenHealth, involves just the area of cancer, sparing the remainder of the prostate.

That is important for two reasons. Number one, it limits the potential side effects that can occur from treatment. And these side effects include sexual dysfunction, leakage of urine, and injury to surrounding tissues. The second potential benefit is that it is a rapid recovery, meaning that because you are treating just a focal area of the prostate and it does not involve any invasive procedure, recovery is relatively quick.

Host: Right. So, I think I have a good understanding here rather than treating everything, blasting everything, if you will, it's more focused, which as you've mentioned here is some benefits for patients in terms of recovery and so forth. So then, let's talk about some of the advantages of HIFU over perhaps other treatment options.

Dr. Marco Salazar: The best way to think about HIFU is very analogous to lumpectomy for breast cancer. Previously, when someone had breast cancer, they lost their entire breast. Now, we know that it is safe to remove the cancer and the area around it, and if possible, the remainder of the breast is spared. This has multiple positive effects. Recovery is much quicker, not to mention that all of the effects that address, quality of life, so for example, the way one views himself. Prostate cancer is very similar in that by treating only the cancer and leaving the remainder of the prostate behind, you are having a minimal, and for most men, no impact on sexual function. You are having minimal, and for most men, no impact on urinary function. So in fact, the way a man sees himself and feels about himself is preserved.

Host: That's really interesting. And that's a great analogy. Just wondering which patients are a good candidate for this type of treatment.

Dr. Marco Salazar: Throughout the country, there are different criteria depending on the institution. At Evergreen, we have elected to choose men that have a particular kind or a particular flavor of cancer. And the technical term we use is a grade. So, in this case, we recommend men with Gleason 3+4 or what's called grade group 2 cancer, could be considered this modality.

The second thing is that the cancer is localized. We use MRI as a way to identify the cancer. And so if on an MRI and subsequently a focused biopsy demonstrates that the cancer is only located at the site of the MRI lesion, that allows us to target that region and spare the remainder of the prostate without leaving any prostate cancer behind.

Host: Yeah, it's really amazing. And I don't know if it's possible in an audio podcast, but can you give us a sense at least of what happens during the HIFU procedure?

Dr. Marco Salazar: Once a man goes to sleep, because this is done under a general anesthetic, and a special ultrasound probe is placed into the rectum through the anus, the ultrasound then allows visualization of the entire prostate and the area that is to be treated is then localized, there are treatment settings that are put into the machine and then the treatment is administered. There are no cuts involved in this procedure. There is no radiation involved in this procedure. This is completely done by ultrasound. And the area of the prostate that is treated is treated by heat. So, high-intensity focused ultrasound is very analogous to taking a magnifying glass and focusing the energy of the sun onto a focal point. And that is in essence what we do with HIFU. We find the area that is of interest. We focus the HIFU energy onto that area. And then, over the course of one to two hours, that area is basically destroyed. And because we are able to use ultrasound to guide the location of the beam, we can be sure that we are not injuring adjacent structures, such as the nerves that are responsible for erections and the urethra, the tube through which a man pees, and the muscles that help a man hold his urine.

Host: Let's finish up today and just talk about recovery time from HIFU treatment. How does it differ from some of the other options?

Dr. Marco Salazar: So, recovery is very quick. So, there is a seven-day period in which a man wears a catheter. That is a tube that goes from the outside world through the penis into his bladder. And what it allows is the urine that is being produced and typically stored in the bladder to be released from the body. The reason we do that is because anytime you injure any organ of the body, including the prostate, you will develop swelling. And if the prostate swells, well, it will make it more difficult, if not impossible, for the urine to come out. It's very similar to when you develop a cold and you can't breathe through your nose. It is because the swelling does not allow to go through the nasal passage. Well, same thing occurs when you injure the prostate. So as a safety mechanism, we put the catheter in for seven days. Once the catheter is removed, there are no activity restrictions, meaning that a man can resume sexual function, can resume all exercise, can go back to work. And so, it is a very quick recovery.

Now, that's not to say that a man will be normal after seven days, but the majority of activities can be resumed safely. And so, this is in comparison to, for example, surgery where you require four to six weeks to heal from the incisions and all of the other trauma that occurred to the body and from radiation where there's an effect where the body recovers over months as the radiation effect matures and the body's initial response to the injury subsides.

Host: Well, it's all pretty amazing. You know, as you say, open surgery, radiation, you're talking about weeks in the case of HIFU, seven days and you're feeling pretty good, maybe not a hundred percent, but you're getting there. Really great to learn about HIFU today. Thank you so much, and you stay well.

Dr. Marco Salazar: Thank you. You too. Bye-bye now.

Scott Webb: EvergreenHealth Urology Care provides expert evaluation and treatment for complex urological conditions. To schedule an appointment, please visit the EvergreenHealth Urology Care website at evergreenhealth.com/urology-care or call 425-899-5800. That's 425-899-5800. I'm Scott Webb. And please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.