Patients who have localized prostate cancer disease and can tolerate anesthesia

Patients who do not want to partake in watchful waiting of their prostate cancer disease

Patients that have studied and understood their treatment options for prostate cancer and have elected NOT to undergo surgery,radiation or cryoablation

Patients who need retreatment for prostate cancer recurrences after:

• radiation
• brachytherapy
• proton beam
• cyberknife
• surgery
• cryoablation

Preoperative Testing and Preparation

Once a man has been diagnosed with prostate cancer and subsequent imaging studies have suggested localized prostate disease then several ultrasound criteria are important to review prior to undergoing the transrectal HIFU(see prostate cancer www.urologyweb.com ).

Ultrasound Criteria

Prostate Volume

The bigger the volume of the prostate the longer the procedure time. For example, with the present software we calculate about an hour per 10 grams of prostate. Prostates 30g or over are usually downsized to a more manageable volume with a combination of lupron and avodart. This treatment temporarily arrests the prostate cancer and some men also elect this therapy to allow more time for considering their treatment options in addition to the volume shrinking aspects of these medications. This therapy works because testosterone production from the testicles is temporarily arrested (temporary chemical castration) and this is useful as testosterone has the ability to stimulate prostate cancer growth.
In addition to the prostate volume, the A-P diameter of the prostate is important

Sonographic Details

Sonographic details of the prostate such as cysts (which may require aspiration)or prostatic calcifications which may cause deflection of the Hifu treatment beam may require resection through a trans urethral resection (TURP)

Rectal Wall Thickness

The thickness of the rectal wall is important as a thick wall (which may occur after radiation) may compromize Hifu treatment.

Treatment Procedure

a) Pretreatment
Assuming that the man has localized prostate cancer and has a good life expectancy and is without significant co-morbidities.
the following preoperative preparations are undertaken prior to the Sonablate 500 hifu:

complete metabolic profile
CBC
PT/PTT/INR
EKG
CXR
urine culture
medical clearance
with testing completed within 30 days of the procedure

The anticoagulants
warfarin
coumadin
aspirin- should be stopped 5 days before the procedure
plavix- should be stopped 10 days before the procedure
NPO or stop eating and drinking by midnight prior to your treatment

self administer 2 fleets enemas 2 hours prior to your treatment

b) Treatment
Patient is anesthetized with a general or spinal anesthetic with sedation and then catheterized. A suprapubic catheter may be inserted at this time or the patient catheterized with a foley catheter at the end of the treatment procedure. The patient is then positioned in the lithotomy position and the Sonablate 500 probe covered with a latex condom,filled with bubble free water is inserted into the rectum. The water surrounding the probe is circulated through a chiller to keep the rectal wall relatively cool. The urologic surgeon then maps out the prostatic treatment zones on the computer and once complete and verified,multiple focused pulses of acoustic energy are delivered into the prostate via the probe. The focused high intensity energy delivered kills the cancer in the targeted prostatic tissue.The simultaneous ultrasound imaging during the high intensity treatment allows real time imaging of the prostate and the surrounding tissues to give the surgeon immediate and detailed feedback on treatment progress. This realtime monitoring allows for possible correction of the treatment zone especially allowing for changes in the dimensions of the prostate which may occur from swelling due to the thermal treatment.

Another proprietary technology specific to the Sonablate 500 is the ability to determine effectiveness of the focal ablation site with Tissue Change Monitoring (TCM) so that prostatic tissue inadequately treated can be retargeted for retreatment. In this way advanced ultrasound imaging and treatment occur simultaneously.

Treatment time varies but generally lasts 1 to 4 hours depending upon the size of the prostate.