What is Salvage HIFU?

HIFU Doctor in Los Angeles

Salvage HIFU is the term used when HIFU is performed for patients whose cancer returns after radiation therapy. 

What are the types of radiation treatments used to treat prostate cancer?

There are many different types of radiation:

  • Brachytherapy (seeds)
  • Proton therapy
  • Intensity Modulated Radiation Therapy (IMRT)
  • High-dose Rate (HDR) brachytherapy 
  • Conformal therapy
  • Cyberknife
  • Traditional external beam

Numbers vary but estimates are that 30,000 – 50,000 patients return to urologists’ offices every year as radiation failures. Why you may ask, does this happen?  In delivering radiation therapy of any type, it is extremely important for the radiation oncologist to spare a zone of tissue around the urethra of 5 to 10 millimeters.  The reason for this is that, if the radiation gets too close to the urethra, the result is a “stovepipe urethra.”  This is a rigid tube that causes severe incontinence.  So, because that area of tissue around the urethra cannot be treated, it is a common site of prostate cancer persistence or recurrence.

If cancer returns after radiation, additional radiation is not an option.  The dose administered during the original treatment is usually the maximum safe dosage a body can withstand.  Delivering more energy can cause severe tissue destruction and decomposition so it is not a reasonable treatment option.   

So, if the prostate cancer returns after radiation what are your options?  The principal one is radical surgery.  The challenge, however, is that operating to remove a prostate after radiation is extremely difficult because radiation changes the prostate from a rubbery structure to one with a very hard, non-pliable texture.  Surgical “landmarks” that allow surgeons to identify structures like the urinary sphincter muscle are obliterated.  The result is that all patients typically have severe urinary incontinence afterward.  In many cases, the bladder is fused to the prostate so it may need to be removed, too.  In that event, patients will have a urine drainage bag on their abdomen for the rest of their lives.  Finally, in almost all cases, erectile function is permanently lost.    

Because of these severe lifestyle changes, HIFU is often considered as a way to either cure or at least slow down recurrent cancer.  While the incidence of side effects like urine leakage and erectile dysfunction is higher than if HIFU had been used for initial treatment, they are less than is seen with surgery.

Another option, is select cases, is cryoablation.  By inserting “needles” into the prostate, and running argon gas through them, the internal prostate temperature can be lowered to – 40 degrees centigrade.  The freezing temperature kills all cells that it reaches.  However, one limitation of this is that, just like with radiation, a rim of tissue near the urethra must be left intact.    

With any procedure, other complications can occur, such as scar tissue formation and a fistula. 

It’s extremely important that salvage HIFU procedures of any type be performed by an extremely experienced practitioner to minimize the chances of side effects or complications.  If you have recurrent prostate cancer after radiation, we want you to know that we have a lot of experience at Western States HIFU with this condition.  We’re here to help you – call us to schedule a consultation! 

You can schedule your consultation with Dr. Robert Pugach at one of our two office locations in  Huntington Beach or Los Alamitos, CA.  These offices that are freeway accessible for residents of greater Los Angeles, Orange, Riverside, San Bernardino and San Diego Counties, CA.

 For patients who live out-of-the-area (United States) and for international patients who want to discuss prostate cancer treatment options with Dr. Pugach, we offer telephone and online (virtual) consultations to help you connect with us. 

To schedule a consultation to learn more about HIFU, just call 844-HIFUDOC (844.443.8362) or email us via our Contact Us form on this website. We look forward to welcoming you to Western States HIFU. We’re here to help you!