Alternative Approach Uses Sound Waves to Treat Prostate Cancer

UC San Diego Health is first in San Diego County to employ high-intensity, focused ultrasound for minimally invasive prostate cancer treatment

Bob Damashek was diagnosed with prostate cancer 15 years ago. Due to the early stage and grade of his condition at the time of diagnosis, he was able to avoid surgery and manage his disease through active surveillance by his medical team for any signs of disease progression.

His cancer remained stable until last year.

Testing of Damashek’s prostate-specific antigen (PSA) — a protein produced by normal and malignant cells of the prostate gland — began to rise; a biopsy confirmed his cancer had worsened.

"I have had several family members and friends impacted by prostate cancer," said Damashek. "I know how horrible this disease can be and that getting treatment early is paramount."

That’s when the Denver resident in his 70’s came to UC San Diego Health for a treatment approach not available to him at home.

High-intensity focused ultrasound (HIFU) is a minimally invasive, outpatient treatment for localized prostate cancer. The technology uses high-frequency sound waves directed at the cancerous tissue through an ultrasound probe inserted into the rectum.

The sound waves target and heat the cancerous tissue to temperatures high enough to cause cell death.

HIFU provides an alternative to surgery or radiation for eligible patients. UC San Diego Health is the only hospital system in San Diego County to offer HIFU to prostate cancer patients.

"As the only academic medical center and National Cancer Institute-designated Comprehensive Cancer Center in the region, we can offer patients leading edge treatment not always available at other health care systems," said Scott Lippman, MD, medical oncologist at UC San Diego Health and associate vice chancellor for cancer research and care and professor of medicine at UC San Diego School of Medicine. "Our experts continue to improve approaches for prevention, diagnosing and treating cancers."

Through the advanced HIFU system, high-resolution images are combined with biopsy data and real-time ultrasound imaging to provide urologists with a 3D view of cancerous tissues. Physicians can then draw precise contours around the diseased tissue, ablate only that portion of the affected organ and minimize damage to surrounding structures, which include nerves important for erectile function, blood vessels and muscle tissue. For the patient, the approach minimizes the risk of urinary incontinence and erectile dysfunction.

At the end of the procedure, a temporary urinary catheter is placed to limit the risk of urinary retention (inability to pass urine) due to the temporary swelling of the prostatic urethra. The catheter is typically removed three to five days after the procedure.

"Using a multi-disciplinary approach, we can now treat eligible prostate cancer patients with a state-of-the-art piece of equipment that results in removing cancerous tumors with extreme accuracy and quicker recovery times because no incisions are required," said E. David Crawford, MD, urologic oncologist at UC San Diego Health and Damashek’s physician.

For Damashek, that meant a trip to Disneyland the day after treatment and feeling fully back to himself a few days later.

"The surgery was effective and so easy to tolerate that it boggled my mind," said Damashek. "As a cancer patient, you are always assessing, worrying and sometimes second-guessing the best treatment for your specific case. I am 100 percent confident I made the right decision."

Prostate cancer is the most common solid organ cancer diagnosed and the second leading cause of cancer deaths in males in the United States. When found early and treated appropriately, the five-year survival rate is nearly 100 percent.

Despite the serious nature of some prostate cancers, many cases are non-aggressive. A nuanced, multi-disciplinary and personalized approach is required to give each patient the appropriate treatment at the right time.

UC San Diego Health has world-renowned experts in urology, radiation oncology, medical oncology, radiology and pathology to assist patients in making critical treatment decisions. Crawford said not all men require surgery or radiation.

Ideal candidates for HIFU are those who have early-stage, lowto intermediate-grade cancer that is confined to the prostate. HIFU is used to treat a single tumor containing part of the prostate, half or in all of the gland.

"We have a personalized approach to cancer care at UC San Diego Health, and with HIFU, we have an exciting new way to treat prostate cancer," said Crawford, professor of urology at UC San Diego School of Medicine. "It is like the male equivalent of the female lumpectomy used for certain breast cancers."

Damashek is back to his cardio workouts and resistance training at the gym and fully enjoying life.

"I feel like a big weight has been lifted off my shoulders. For the first time in a very long time, I am not consumed by cancer. My wife and I are so thankful for the treatment I received by a fantastic team at UC San Diego Health."

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