Prostate cancer ranked as the 2nd most diagnosed cancer and the 5th leading cause of cancer-related deaths among men globally. That’s what the American Cancer Society’s 2024 report on global cancer statistics finds from the most recently available set of data.[1]
Today, there is a glimmer of hope that this trend may see a change in the GCC. For the first time in the UAE, patients with prostate cancer and benign prostatic hyperplasia (BPH) – a condition where the prostate gland is enlarged – will have access to Sonablate high-intensity focused ultrasound (HIFU) robotic focal therapy in partnership with CanAm Scientific.
Now, patients no longer need to travel outside the GCC for this innovative technology and can instead access a minimally invasive and bloodless treatment at Clemenceau Medical Center (CMC) hospital in Dubai in an initiative spearheaded by a multidisciplinary team of expert physicians led by Dr. Rabii Madii, one of the world’s leading urologic oncologists and robotic surgeons.
When soundwaves cure cancer
The mechanism is powerfully simple. Once the prostate and treatment area are mapped out using an ultrasound scan, a probe is inserted to precisely deliver the treatment effect through a focal beam guided by a transrectal ultrasound scan. Utilizing high-frequency sound waves, the machine targets a small, precise focal point and generates heat. At 60°C, coagulative necrosis and protein denaturation occur almost instantaneously, destroying the target cells. No surgical incision is made, preserving the surrounding anatomical structure. The prostate is not removed, ensuring minimal-to-no bleeding, reduced risk of complications, more spared nerves, fewer cells destroyed, and ultimately, a faster recovery.
Sonablate HIFU can be offered as a stand-alone procedure or as an integrated part of a larger healthcare approach, either as the first line of defense followed by radiation treatment or as a secondary salvage treatment for recurrence. Recent advancements in HIFU technology also allow for real-time monitoring and adjustments during the procedure, enhancing precision and treatment outcomes. This technology is particularly beneficial for patients with localized prostate cancer, providing a personalized and targeted therapeutic approach.
The ‘new’ normal for prostate cancer treatment?
This new development contrasts with conventional treatments like open radical prostatectomy (ORP) where the surgical access site lies either at the lower abdomen or between the scrotum and anus. Robotic-assisted radical prostatectomy (RARP), considered the gold standard surgical therapy for localized prostate cancers, offers a minimally-invasive approach with technological benefits such as three-dimensional visualization and articulated instruments. However, like any radical intervention, RARP can lead to urinary incontinence and sexual dysfunction.
While conventional approaches have yielded generally positive outcomes, the growing body of scientific research suggests that HIFU promises to outpace the conventional results and set a new standard in treatment efficacy. In properly selected patients, cancer control could be achieved with HIFU without compromising urinary control and preserving sexual functions. A 2022 systematic review of HIFU’s focal treatment for prostate cancer found that between 93% to 97% of patients reported total urinary continence 12 months following their HIFU therapy and self-reported symptoms for erectile function were generally positive, with 69% to 80% patients retaining sufficient erections, a percentage found to improve slightly after six months.[2]
And while 13% to 41% of patients experienced some type of postoperative complication, 85% to 100% of these manifested within 3 months after the procedure and between 80% to 100% of these complications were classified as minor with none requiring any surgical intervention.[3]
Although Sonablate HIFU presents a number of advantages, Dr Rabii Madii explains that the patient’s suitability depends on their oncological progression and medical profile. Proper patient selection is key, and only an expert urologist can recommend the most suitable treatment modality.
A note on side effects
All medical procedures carry some risk, and HIFU is no exception. Potential side effects include pain in the area surrounding the prostate, blood and prostate tissue in the urine, urinary tract infections, infection in the testicles, difficulty passing urine due to tissue swelling, erectile dysfunction, and incontinence. However, it’s essential to note that these side effects are not specific to HIFU, and patients undergoing RARP or LRP can typically expect similar outcomes.
As with any medical procedure, close collaboration between the patient and the healthcare team is crucial to manage expectations and address concerns. Regular follow-up appointments and communication with healthcare providers help monitor recovery progress and manage any potential side effects promptly.
Patient suitability: Not everyone is eligible
Although HIFU presents several advantages, Dr. Rabii Madii emphasizes that the patient’s suitability depends on their oncological progression and medical profile. The ideal HIFU candidate is a low-to-intermediate risk patient with tumors confined to the prostate, a Gleason score of 6 or 7, and PSA levels less than 20 ng/ml. High-risk patients, defined as those with a tumor that has grown outside the prostate, a Gleason score of 8 to 10, or PSA levels exceeding 20 ng/ml, will require an alternative and more aggressive treatment, such as radiation therapy or surgery.
Recent studies have explored the use of HIFU in conjunction with advanced imaging techniques, such as multiparametric magnetic resonance imaging (mpMRI), to enhance patient selection and treatment precision. This approach allows for a more accurate assessment of tumor characteristics, aiding in the identification of suitable candidates for HIFU therapy. And while the exploration of HIFU’s applications in treating other conditions is still in its early stages, the surgical field is witnessing promising developments as it becomes more technologically adept and driven by innovation.
In summary, the choice between HIFU and robotic prostatectomy depends on individual circumstances, patient preferences, and the characteristics of the cancer. It is crucial for patients to engage in detailed discussions with their urologists to determine the most appropriate treatment plan for their specific situation. Regular advancements in technology and treatment protocols continue to shape the landscape of prostate cancer care, offering patients more personalized and effective options.
HIFU’s arrival in Dubai marks an important milestone, not only demonstrating the UAE’s healthcare sector’s commitment to embracing cutting-edge medical technologies, but also solidifying the position of the Emirate as a healthcare hub and a prime destination for medical tourism, attracting individuals from around the region seeking innovative treatments.
As these technologies become increasingly available and physicians trained to fully utilize them, it is the patient who stands to benefit the most through a less invasive treatment with better outcomes and faster recovery. One advancement at a time, we edge closer to a future where the Emirate’s surgeons might soon swap their scalpels for controllers, heralding a new era in surgical precision and patient care.
References:
- American Cancer Society, “Global Cancer Facts & Figures 5th Edition,” (2024). Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/global-cancer-facts-and-figures/global-cancer-facts-and-figures-2024.pdf
- Arnas Bakavicius, Giancarlo Marra, Petr Macek,, Cary Robertson, Andre L. Abreu, Arvin K. George, Bernard Malavaud, Patrick Coloby, Pascal Rischmann, Marco Moschini, Ardeshir R. Rastinehad, Abhinav Sidana, Armando Stabile, Rafael Tourinho-Barbosa, Jean de la Rosette, Hashim Ahmed, Thomas Polascik, Xavier Cathelineau and Rafael Sanchez-Salas, “Available evidence on HIFU for focal treatment of prostate cancer: a systematic review,” International Brazilian Journal of Urology 48 (2022), pp. 263-74. Available at https://www.scielo.br/j/ibju/a/TfBygqLDznm4n9BV76MxttF/?format=pdf&lang=en
- Bakavicius et al, “Available evidence on HIFU for focal treatment of prostate cancer: a systematic review,” International Brazilian Journal of Urology 48 (2022), pp. 263-74. Available at https://www.scielo.br/j/ibju/a/TfBygqLDznm4n9BV76MxttF/?format=pdf&lang=en
