Focused ultrasound treatment for the prostate is available in the United States.
Three focused ultrasound systems for destroying diseased prostate tissue are approved by the Food and Drug Administration. In addition, Medicare has taken initial steps to cover this treatment, which will hopefully impact the commercial carriers to do the same.
Focused Ultrasound Therapy
Focused ultrasound is a noninvasive, radiation-free method to destroy prostate tissue and treat prostate disease. Using real-time image guidance, the physician directs a focused beam of ultrasound energy to a selected volume in the patient’s prostate gland.
How it Works
Focused ultrasound energy heats and destroys the targeted tissue at the focal point within seconds. This process is repeated until the entire selected volume or the entire gland is destroyed.
The primary options for treatment of prostate cancer include the avoidance of invasive procedures that may include ionizing radiation and surgery.
Focused ultrasound is a low-morbidity treatment that usually only requires a single therapy session and has a short recovery time. It is reported to have a low complication rate, especially when considering post-procedure impotence and incontinence. Focused ultrasound treatment does not use ionizing radiation, and it is possible to offer it as a salvage therapy for patients who fail radiation treatment. Focused ultrasound treatment can be a complement to drug therapy, enabling enhanced delivery of chemotherapy or immunotherapy to tumors, and it may potentially induce an anti-tumor immune response.
There are numerous clinical trials worldwide using focused ultrasound to treat prostate cancer.
Regulatory Approval and Reimbursement
Focused ultrasound devices have been cleared to treat the prostate in approximately 50 countries, including the United States. Several systems for focused ultrasound ablation of prostate tissue are available in various geographical regions, each differing in their guidance method (ultrasound vs. magnetic resonance imaging) and approach – transrectal or transurethral.
While the Foundation attempts to keep the list of sites complete, there have been many purchases of the focused ultrasound systems. For the latest information on availability, we recommend contacting the manufacturers’ directly or using their online search functions. Find a center near you >
There are three focused ultrasound manufacturers that are approved in the US for the ablation (destruction) of prostate tissue – Sonablate Corp., EDAP-TMS, and Profound Medical. Sonablate and EDAP deliver care outside of the MRI facility, so they are found in surgery centers and surgical suites, as well as in hospitals.
There are additional sites that use mobile focused ultrasound equipment. These sites may not be listed on the EDAP, Sonablate, or Profound Medical sites, and the best way to find them is to contact local urologists to see if they have focused ultrasound capability.
Reimbursement for primary treatment in the US has been lagging, and Medicare and most insurance companies are either covering a portion of the expense or not covering it at all. In the specific instance of salvage therapy after failed radiation, some Medicare providers and commercial insurance carriers are covering focused ultrasound use in this setting. As always, it is best to check with your specific carrier.
Abrams LR, Koch MO, Bahler CD. Focal High-Intensity Focused Ultrasound Ablation of the Prostate. J Endourol. 2021 Sep;35(S2):S24-S32. doi: 10.1089/end.2020.1161.
Shoji S, Uchida T, Hanada I, Takahashi K, Yuzuriha S, Kano T, Ogawa T, Umemoto T, Kawakami M, Nitta M, Hashida K, Hasegawa M, Hasebe T, Miyajima A. Analysis of oncological outcomes of whole-gland therapy with high-intensity focused ultrasound for localized prostate cancer in clinical and technical aspects: a retrospective consecutive case-series analysis with a median 5-year follow-up. Int J Hyperthermia. 2021;38(1):1205-1216. doi: 10.1080/02656736.2021.1945150.
Rompré-Brodeur A, Marcq G, Tholomier C, Fugaru I, Loutochin O, Anidjar M, Bladou F. Role of Systematic Control Biopsies Following Partial Gland Ablation with High-Intensity Focused Ultrasound for Clinically Significant Prostate Cancer. J Urol. 2021 Jul 12:101097JU0000000000001934. doi: 10.1097/JU.0000000000001934.
Spitznagel T, Hardenberg JV, Schmid FA, Rupp NJ, Westhoff N, Worst TS, Weis CA, Mortezavi A, Eberli D. Salvage robotic-assisted laparoscopic radical prostatectomy following focal high-intensity focused ultrasound for ISUP 2/3 cancer. Urology. 2021 Jun 26:S0090-4295(21)00569-0. doi: 10.1016/j.urology.2021.04.059.
Shi R, Chong KT, Tan PH. Histopathological features of recurrent prostate adenocarcinoma after high intensity focused ultrasound (HIFU) focal treatment: A case report. Urol Case Rep. 2021 Jun 6;38:101744. doi: 10.1016/j.eucr.2021.101744. eCollection 2021 Sep.
Napoli A, Alfieri G, Scipione R, Leonardi A, Fierro D, Panebianco V, De Nunzio C, Leonardo C, Catalano C. High-intensity focused ultrasound for prostate cancer. Expert Rev Med Devices. 2020 May;17(5):427-433. doi: 10.1080/17434440.2020.1755258.
Rakauskas A, Shah TT, Peters M, Randeva JS, Hosking-Jervis F, Schmainda MJ, Orczyck C, Emberton M, Arya M, Moore C, Ahmed HU. Can quantitative analysis of multi-parametric MRI independently predict failure of focal salvage HIFU therapy in men with radio-recurrent prostate cancer? Urol Oncol. 2021 May 25:S1078-1439(21)00176-9. doi: 10.1016/j.urolonc.2021.04.017.
Checcucci E, De Luca S, Piramide F, Garrou D, Mosca A, Galla A, Belli G, Russo F, Rescigno P, Poti C, Amparore D, Verri P, Volpi G, Manfredi M, Fiori C, Porpiglia F. The real-time intraoperative guidance of the new HIFU Focal-One() platform allows to minimize the perioperative adverse events in salvage setting. J Ultrasound. 2021 May 24. doi: 10.1007/s40477-021-00594-8.
Lopez W, Nguyen N, Cao J, Eddow C, Shung KK, Lee NS, Chow MSS. Ultrasound Therapy, Chemotherapy and Their Combination for Prostate Cancer. Technol Cancer Res Treat. 2021 Jan-Dec;20:15330338211011965. doi: 10.1177/15330338211011965.
Dellabella M, Branchi A, Di Rosa M, Pucci M, Gasparri L, Claudini R, Carnevali F, Cecchini S, Castellani D. Oncological and functional outcome after partial prostate HIFU ablation with Focal-One(): a prospective single-center study. Prostate Cancer Prostatic Dis. 2021 May 18. doi: 10.1038/s41391-021-00390-9.
Magee D, Perlis N, Corr K, Chan R, Gertner M, Zisman A, Jokhu S, Ghai S. Salvage interstitial laser thermal therapy under MRI guidance (MRgFLA) for high-intensity focal ultrasound (HIFU) recurrences: feasibility study. Clin Imaging. 2021 Apr 28;76:217-221. doi: 10.1016/j.clinimag.2021.04.014.
van Son MJ, Peters M, Reddy D, Shah TT, Hosking-Jervis F, Robinson S, Lagendijk JJW, Mangar S, Dudderidge T, McCracken S, Hindley RG, Emara A, Nigam R, Persad R, Virdi J, Lewi H, Moore C, Orczyk C, Emberton M, Arya M, Ahmed HU, van der Voort van Zyp JRN, Winkler M, Falconer A. Conventional radical versus focal treatment for localised prostate cancer: a propensity score weighted comparison of 6-year tumour control. Prostate Cancer Prostatic Dis. 2021 May 1. doi: 10.1038/s41391-021-00369-6.
Ahmadi Bidakhvidi N, Laenen A, Jentjens S, Deroose CM, Van Laere K, De Wever L, Mai C, Berghen C, De Meerleer G, Haustermans K, Joniau S, Everaerts W, Goffin K. Parameters predicting [18F]PSMA-1007 scan positivity and type and number of detected lesions in patients with biochemical recurrence of prostate cancer. EJNMMI Res. 2021 Apr 30;11(1):41. doi: 10.1186/s13550-021-00783-w.
Pye H, Singh S, Norris JM, Carmona Echeverria LM, Stavrinides V, Grey A, Dinneen E, Pilavachi E, Clemente J, Heavey S, Stopka-Farooqui U, Simpson BS, Bonet-Carne E, Patel D, Barker P, Burling K, Stevens N, Ng T, Panagiotaki E, Hawkes D, Alexander DC, Rodriguez-Justo M, Haider A, Freeman A, Kirkham A, Atkinson D, Allen C, Shaw G, Beeston T, Brizmohun Appayya M, Latifoltojar A, Johnston EW, Emberton M, Moore CM, Ahmed HU, Punwani S, Whitaker HC. Evaluation of PSA and PSA Density in a Multiparametric Magnetic Resonance Imaging-Directed Diagnostic Pathway for Suspected Prostate Cancer: The INNOVATE Trial. Cancers (Basel). 2021 Apr 20;13(8):1985. doi: 10.3390/cancers13081985.
Cathcart P, Ribeiro L, Moore C, Ahmed HU, Leslie T, Arya M, Orczyk C, Hindley RG, Cahill F, Prendergast A, Coetzee C, Yogeswaran Y, Tunna K, Sooriakumaran P, Emberton M. Outcomes of the RAFT trial: robotic surgery after focal therapy. BJU Int. 2021 Apr 23. doi: 10.1111/bju.15432.
Stabile A, Sanchez-Salas R, Tourinho-Barbosa R, Macek P, Pellegrino F, Gandaglia G, Moschini M, Cathala N, Mombet A, Montorsi F, Briganti A, Cathelineau X. Association Between Lesion Location and Oncological Outcomes after Focal Therapy for Localized Prostate Cancer Using Either High Intensity Focused Ultrasound or Cryotherapy. J Urol. 2021 Apr 23:101097JU0000000000001787. doi: 10.1097/JU.0000000000001787.
von Hardenberg J, Cash H, Koch D, Borkowetz A, Bruendl J, Leyh-Bannurah SR, Kuru TH, Kowalewski KF, Schindele D, Mala KS, Westhoff N, Blana A, Schostak M; Working Group of Focal and Microtherapy of the German Society of Urology (DGU). Triggers and oncologic outcome of salvage radical prostatectomy, salvage radiotherapy and active surveillance after focal therapy of prostate cancer. World J Urol. 2021 Apr 21. doi: 10.1007/s00345-021-03700-x.
Berends J, Dupati A, Dibianco J, George AK. Focal Therapy is a viable treatment for low risk Prostate cancer. J Endourol. 2021 Apr 13. doi: 10.1089/end.2021.0235.
Khedime S, Gelet A, Rouvière O, Lafon C, Badet L, Crouzet S, Hostiou T. Salvage High-Intensity Focused Ultrasound for Local Recurrence in the Prostatic Bed after Prostatectomy and Adjuvant or Salvage Radiotherapy: Preliminary Results. J Urol. 2021 Apr 9:101097JU0000000000001771. doi: 10.1097/JU.0000000000001771.
Lomas DJ, Woodrum DA, Mynderse LA. Salvage ablation for locally recurrent prostate cancer. Curr Opin Urol. 2021 May 1;31(3):188-193. doi: 10.1097/MOU.0000000000000861.
Afshar-Oromieh A, da Cunha ML, Wagner J, Haberkorn U, Debus N, Weber W, Eiber M, Holland-Letz T, Rauscher I. Performance of [68Ga]Ga-PSMA-11 PET/CT in patients with recurrent prostate cancer after prostatectomy-a multi-centre evaluation of 2533 patients. Eur J Nucl Med Mol Imaging. 2021 Feb 4. doi: 10.1007/s00259-021-05189-3.
Giannakou M, Drakos T, Menikou G, Evripidou N, Filippou A, Spanoudes K, Ioannou L, Damianou C. Magnetic resonance image-guided focused ultrasound robotic system for transrectal prostate cancer therapy. Int J Med Robot. 2021 Feb 2. doi: 10.1002/rcs.2237.
Ghai S, Finelli A, Corr K, Chan R, Jokhu S, Li X, McCluskey S, Konukhova A, Hlasny E, van der Kwast TH, Incze PF, Zlotta AR, Hamilton RJ, Haider MA, Kucharczyk W, Perlis N. MRI-guided Focused Ultrasound Ablation for Localized Intermediate-Risk Prostate Cancer: Early Results of a Phase II Trial. Radiology. 2021 Mar;298(3):695-703. doi: 10.1148/radiol.2021202717. Epub 2021 Feb 2.
Shah TT, Reddy D, Peters M, Ball D, Kim NH, Gomez EG, Miah S, Evans DE, Guillaumier S, van Rossum PSN, Van Son MJ, Hosking-Jervis F, Dudderidge T, Hindley R, Emara A, McCracken S, Greene D, Nigam R, McCartan N, Valerio M, Minhas S, Afzal N, Lewi H, Ogden C, Persad R, Virdi J, Moore CM, Arya M, Emberton M, Ahmed HU, Winkler M. Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study. Prostate Cancer Prostatic Dis. 2021 Jan 28. doi: 10.1038/s41391-020-00315-y.
Hanada I, Shoji S, Takeda K, Uchida T, Yuzuriha S, Kuroda S, Ogawa T, Higure T, Nakano M, Kawakami M, Nitta M, Hasegawa M, Kawamura Y, Miyajima A. Significant impact of the anterior transition zone portion treatment on urinary function after focal therapy with high-intensity focused ultrasound for prostate cancer. J Endourol. 2021 Jan 26. doi: 10.1089/end.2020.0872.
Bründl J, Osberghaus V, Zeman F, Breyer J, Ganzer R, Blana A, Gierth M, Denzinger S, Burger M, Rosenhammer B. Oncological Long-term Outcome After Whole-gland High-intensity Focused Ultrasound for Prostate Cancer-21-yr Follow-up. Eur Urol Focus. 2021 Jan 19:S2405-4569(20)30318-7. doi: 10.1016/j.euf.2020.12.016.
Bates AS, Ayers J, Kostakopoulos N, Lumsden T, Schoots IG, Willemse PM, Yuan Y, van den Bergh RCN, Grummet JP, van der Poel HG, Rouvière O, Moris L, Cumberbatch MG, Lardas M, Liew M, Van den Broeck T, Gandaglia G, Fossati N, Briers E, De Santis M, Fanti S, Gillessen S, Oprea-Lager DE, Ploussard G, Henry AM, Tilki D, van der Kwast TH, Wiegel T, N'Dow J, Mason MD, Cornford P, Mottet N, Lam TBL. A Systematic Review of Focal Ablative Therapy for Clinically Localised Prostate Cancer in Comparison with Standard Management Options: Limitations of the Available Evidence and Recommendations for Clinical Practice and Further Research. Eur Urol Oncol. 2021 Jan 8:S2588-9311(20)30216-9. doi: 10.1016/j.euo.2020.12.008.
Click here for additional references from PubMed.
Video courtesy of SonaCare Medical