Q: When and how did you get interested in focused ultrasound for prostate?
I became interested in High-Intensity Focused Ultrasound in 2006, shortly after arriving at M.D. Anderson Cancer Center and initiating research in Focal Therapy for Prostate Cancer. While there were some ablative energies available to effectively apply concepts of organ preservation to prostate cancer treatment, they seemed rather broad stroked. I needed a tool that could allow me more precision, control and confidence that I could destroy tissue effectively and reliably without injury to surrounding structures such as the rectum, urethra or neurovascular bundles.
Q: Please describe the current nature and scope of your focused ultrasound research program for treating the prostate.
Currently we are revamping our program for focal therapy of prostate tumors. Dynamic MRI has altered our approach to focal therapy, both in the diagnosis of prostate cancer and the application of ablative energy to the prostate. While we are offering focal cryoablation still, we are adopting our protocols to incorporate MRI information. We are also working to bring HIFU (both transrectal and MRI directed) into our armamentarium for focal therapy
Q: What focused ultrasound system(s) do you use?
We are in the process of putting together our business plan to purchase the EDAP Ablatherm system and ultimately the FocalOne system when it becomes available in the US.
Q: Please describe the status of focal therapy for men with prostate cancer, in terms of your research and the general trends in the field right now.
Focal therapy for prostate cancer needs to remain investigational. Though MRI has brought great promise to the field, it is neither sensitive nor specific enough to rely upon fully to guide prostate cancer focal therapy and follow-up. While it is easy to “sell” the layperson on the concept of focal therapy, much of the hard research supporting it still needs to be done. Everything from identifying the most appropriate patient for focal therapy, to the best ablative energy to destroy targeted tissue with minimal side-effects, to the appropriate means of follow-up has still to be defined. Prostate cancer is a field with a lot of opinions and a lot at stake financially for both the supporters of focal therapy and especially the detractors of focal therapy who may lose patients if this proves to be effective. I still encourage patients to undergo focal therapy only under the control of a well-developed research platform.
Q: How does FUS fit into M.D. Anderson's overall prostate program? What percentage of patients get FUS treatment compared to other approaches? Is this changing? How many patients have you/M.D. Anderson treated with focused ultrasound for the prostate?
We are just beginning to lay the ground work to bring FUS into our program. We actively participated in all US trials of HIFU for prostate cancer, both EDAP- and SonaCare-sponsored FDA registration trials. So we have one of the nation’s largest experiences with both major HIFU platforms during their research and investigation phases. This will enable us to quickly ramp up our therapeutic program once the equipment has been purchased.
Q: Please tell us about your research/treatment team - internal/external collaborators?
My team consists of two GU radiologists dedicated to prostate MRI interpretation, two interventional radiologists pursuing alternative approaches to prostate access (e.g. transgluteal rather than transrectal), a single dedicated GU pathologist, two dedicated research nurses, and multiple operating room technicians who have worked with me and my team to develop the FUS platform during clinical trials and the Image guided prostate biopsy program we now run.
Q: Can you share some thoughts about what the FDA approvals of SonaCare and Ablatherm for the ablation of prostate tissue mean for men with prostate disease in the US?
These approvals will allow men access to the la technology for effective prostate cancer treatment without having to travel outside of the US for care. It will greatly impact the number of men who can afford this treatment and have reliable follow-up and after care from the same physician and team who performed the treatment, something gravely lacking prior to these approvals.
Q: Where do you think that FUS should fit in the treatment of prostate cancer?
I feel this will have the grea impact on men with minimal disease seeking treatment that want to avoid the side-effects of radical treatments (radical radiation therapy, radical prostatectomy) and find the decades of repeat prostate biopsy and guessing associated with active surveillance equally unpalatable. At the beginning there will be the naysayers and there will be a learning curve; that is why it is important for men seeking this in the US to come to centers such as M.D. Anderson who have extensive experience with this therapy while others are just beginning their experience. With time, the scope of patients who will effectively be treated with FUS will grow.
Q: What do you think about the potential role of the Focused Ultrasound Foundation in advancing the technology for prostate treatment?
We need patient advocacy to overcome some of the internal political and financial head winds to change in the care of men with prostate cancer. The diagnosis and treatment of prostate cancer has made a lot of money for many people in medicine related fields. Anytime you are talking about a paradigm shift in the treatment of this most common of diseases, these parties are at risk of losing their share of the pie and will vigorously push back, often with unsubstantiated claims. The focused Ultrasound Foundation can serve as a rational voice coming from the only party that should really matter in this debate, the patient.