Prostate cancer is the most common cancer among men in the U.S., with about 1 in 8 men diagnosed during their lifetime, and incidence rates continue to rise. However, thanks to advancements in treatment and early detection, the overall survival rate for prostate cancer remains high at 97%. 

Among the latest advancements in prostate cancer treatment is high-intensity focused ultrasound, or HIFU. This minimally invasive therapy concentrates ultrasound waves — those under the audible spectrum of sound to humans — to generate heat and kill cancer cells. For Prostate Cancer Awareness Month, we spoke with Parth K. Shah, M.D., a urologist at Texas Urology Specialists–Fort Worth Clearfork, about this game-changing new treatment. 

1) How does HIFU compare to more conventional treatments like surgery or radiation therapy? 

With HIFU, we're only treating the portions of the prostate that have cancer and avoiding the parts of the prostate that don't have cancer. This allows us to minimize the side effects associated with whole-gland treatments — like surgery and radiation therapy — and preserve the patient’s urinary and sexual function. After HIFU treatment, patients may experience pain and soreness for a few days, and there may be some temporary changes in how they urinate. However, once they heal — typically about a week or so later — they're back to normal. 

2) What criteria do you use to determine whether a patient is a suitable candidate for HIFU, and are there specific cases where this treatment is particularly advantageous? 

Overall, to be a good candidate for HIFU, the patient’s cancer must be localized to one part of the prostate, and it should be visible on an MRI or a PET scan, so we can see where the bulk of the disease is and select that area for treatment. 

There are some instances where HIFU is particularly advantageous. For example, a patient who has undergone treatment for prostate cancer with radiation therapy and then has a recurrence of the disease would be a good candidate. This is because radiation changes tissue at a microscopic level, so surgically removing the prostate after radiation therapy may not be feasible. Additionally, all the side effects we try to prevent, like incontinence and erectile dysfunction, are more severe when a patient undergoes surgery after radiation therapy. In this case, HIFU would be a safer alternative.  

3) Can you describe the role of a urologist in managing a prostate cancer patient’s treatment plan from diagnosis through treatment and follow-up? 

As a urologist, not only do I screen for prostate cancer by testing patients for elevated prostate-specific antigen (PSA) levels in the blood, but I also perform biopsies to diagnose patients with prostate cancer. Then, because the treatment for prostate cancer can involve multiple procedures, I will coordinate the patient’s next steps, sometimes alongside a medical oncologist or radiation oncologist. 

4) What are the benefits of having a multidisciplinary team within the same practice when treating prostate cancer? 

For the patient, I think of it this way: If I have to make a treatment decision that will impact my life, I want to explore all my options to ensure I’m choosing the right approach for me. Being part of a multidisciplinary organization like Texas Oncology means that if a patient wants a second opinion or doesn’t respond to initial treatment, we can easily refer them to a colleague in a different subspecialty, allowing us to expedite care.  

Additionally, because we’re all connected, we have direct access to patient records, further decreasing the burden on patients. Having multiple specialists under one roof also means we see every case from every angle, allowing us to make the best possible treatment recommendation. 

5) What advancements in prostate cancer detection and treatment are you most excited about? 

We're getting better and better at imaging the prostate. We now have prostate MRIs that can pick up tumors within the prostate, which we were not able to do with traditional ultrasound. PET scans allow us to identify the specific areas of the prostate that are making more PSA, which is a protein that cancer cells overproduce. 

So, logically, if we can identify the area making more PSA, we should be able to send medicine to that spot. This approach is called personalized medicine, and for prostate cancer, it involves molecular targeting of cells that are expressing PSA. These are all things that are already in the pipeline, and that's where I anticipate the field will continue to go.