The Difference Between Total and Focal HIFU
There are two ways HIFU can be done. Total gland HIFU means the entire prostate is treated – from front to back, side to side and top to bottom. Focal HIFU means a part, or parts, of the prostate, are treated. Other areas of the prostate are left intact. Oftentimes, patients face a difficult choice in deciding which one may be best so let’s compare them. (View Dr. Robert Pugach’s HIFU procedure video.)
Comparison of Total Gland HIFU and Focal HIFU
Total gland HIFU is the most common form of HIFU treatment. It is the method that was used when HIFU began to be done almost 20 years ago. It is the method most commonly used throughout the world.
Having total gland HIFU means that no area of the prostate is spared. It is appropriate when both sides of the prostate contain multiple or large areas of cancer cells. Below are some of the advantages of total gland HIFU:
- When there are many areas of the prostate that contain cancer, or if there are large concentrations of cancer cells, eradicating all of the cells in the prostate is usually the best strategy. Failure to do so may leave cancer cells untreated and allow them to grow and spread over time.
- Biopsies may miss areas of cancer. With the standard “template” biopsy, 12 different areas of the prostate are sampled. While it certainly feels like a lot of tissue is being taken while the biopsy is being done, the truth is that only about 0.4% of the prostate is sampled. So, 99,6% is unknown. That means that areas, where the biopsies are negative, can harbor cancer cells. Not treating them could result in more cancer growth in these areas.
- Similarly, imaging studies like multiparametric MRIs and ultrasounds often do not see areas of cancer. This is called a false negative study. Once again, not treating areas of the prostate that do not show cancer on imaging studies may result in incomplete treatment.
So, to be sure all areas of cancer are treated, total gland HIFU is an excellent answer.
Role of Focal HIFU
With that said, there is a role for Focal HIFU treatments. Focal HIFU means that a select area, or multiple defined areas, in the prostate are targeted with HIFU energy. If indeed, there are only limited areas of significant cancer, a focal treatment may be all that is needed.
It may be appropriate when biopsies show a small area of cancer or when a decision is made to only treat areas of aggressive cancer, leaving areas of slow-growing cancer alone. The rationale for this is that many low-grade cancers will never require treatment so they do not need treatment. The analogy is a lumpectomy in women with breast cancer. In many cases, healthy breast tissue is spared to minimize disfigurement or side effects.
The advantage to focal HIFU is that a catheter is only required for a few days versus two weeks or so when total gland HIFU is done. The incidence of urine leakage after focal HIFU is less than 1% and erectile dysfunction occurs in less than 5% of patients.
The decision to have total gland or focal HIFU is oftentimes not an easy one. That’s why it is so important to choose a HIFU physician with years of experience. At Western States HIFU, we’re proud to have Dr. Pugach as our medical director. He has been doing HIFU since 2005 and is acknowledged as one of the most experienced HIFU practitioners in the world. Western States HIFU is proud to be the most experienced HIFU center in the Western United States and welcomes patients from all areas of the United States and throughout the world.