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Does HIFU treatment require a TURP  procedure first?

 

Is a TURP required for HIFU: The short answer is sometimes. Continue reading to learn more about the use of TURP with HIFU. Note that Focal or Targeted MRI Fusion Guided HIFU treatment to only a region of the prostate  gland does NOT require a TYRP.

What is a TURP?

TURP stands for: transurethral resection of the prostate gland. This procedure is an established urologic procedure to open a blocked urinary channel when the prostate is enlarged. It is NOT a cure for prostate cancer. Today, this " channel opening or coring out" procedure is often referred to as a vaporization, as we usually do not actaully cut away any tissues, but, rather use laser or "plasma button " technology to apply energy through a telescope to the inner core of the prostate channel (urethra) while a patient is under anesthesia at an outpatient surgery center. This minimally invasive apporach usually takes about 30 minutes and patients are discharged form the surgery center within 1 hour of treatment. A catheter to drain the urine is in place for 12 - 24 hours.

When is a TURP REQUIRED prior to HIFU?

When the prostate gland is significantly enlarged from benign prostate enlargement,  and the size of the prostate is over 40 cc, and the ENTIRE prostate needs treatment, a TURP procedure is often recomended prior  to HIFU  to allow for passage of dead prostate tissues and allow for rapid return to normal urinary function. If a TURP procedure is done prior to HIFU, then a Suprapubic tube (catheter placed through an incison in the abdominal wall, into the bladder), WILL NOT BE REQUIRED. Instead, a standard Foley catheter is used for approximately 7 days to drain the urine as the prostate heals after HIFU treatment. A careful review of ultrasound or MRI images will allow the HIFU surgeon to determine if a TURP procedure is absolutely required. It is important to uderstand that successful HIFU treatment requires that high energy sound waves can reach the entire prostate gland. If the prostate is too large, then it must be reduced in size and this  is one of the reasons why a TURP is required.

Can a large prostate be shrunk with medications?

In cases where the prostate is only minimally enlarged, medications can be used to shrink the prostate. These medications all interfere with testosterone and may cause temporary sexual side effects. Typical oral medications that are often used are (5 alpha reductase inhibitors) such as dutasteride or finasteride or testosterone receptor blockers such as bicalutamide. These medications have minor sexual side effects that will stop once the medication is stopped and can reduce prostate volume by 10 - 20% . However, there is still  prostate tissue that surrounds the prostate channel (urethra)  and can block the channel after HIFU, so a suprapubic catheter ( SP tube) is commonly used post HIFU for approximately 3 weeks. Some urologists will prescribe medications given by injection that will produce temporary castration and reduce testosterone levels to nearly zero. These medications ( Lupron, Zoladex, Trelstar, Degarelix) are designed to be used for advanced prostate cancer , but may be used prior to HIFU to shrink the prostate gland. Although they are efffective in reducing prostate side, they will cause severe sexual side effects that can be permanent as well as significant metabolic abnormailities. They have been shown to increase the risk of heart disease related events (heart attacks) in men with pre exisiting heart disease. It is the opinion of the Scionti Prostate Center, that these medications should NOT be used to shrink the prostate gland prior to HIFU as the side effecs that they cause are exactly the side effects that patients are trying to avoid by undergoing HIFU unless there are no other options.

The Scionti Prostate Center Protocol for TURP prior to HIFU:

Although not absolutely required, Dr. Scionti recomends a TURP type channel opening procedure prior to HIFU in all patients who require the entire prostate to be treated by HIFU. A TURP is NOT required in partial gland targeted ( FOCAL) treatment. This combination apporach allows for a  shorter catheter time post HIFU, a faster return to normal urinary function, a lower risk of urinary infection (due to shorter catheter time), and less chance of scarring or blockage of the urinary channel after HIFU. A recent study published out of the UK in which patients  had total gland HIFU with a suprapubic tube (NO TURP) , showed that 30% of men required surgery after HIFU to open a blocked urinary channel, and that scarring of the channel( stricture ) occurred in many of these men. The Scionti Prostate Center Protocol using TURP prior to HIFU has resulted in an average catheter time of 1 week, no SP tube, and a post HIFU surgery rate of less than 2%. These vastly better results justify this 2 step approach. 

Summary

Focal targeted MRI Fusion Guided HIFU does NOT require a pre HIFU TURP. When the entire prostate needs to be treated, then a TURP procedure prior to HIFU will allow for faster recovery of normal urinary function, lower chance of urinary infection, much lower chance of urinary channel blockage or scarring , and the avoidance of a Surapubic or abdominal wall catheter.

A careful review of ultrasound and MRI images, pathology ( Biopsy )  as well as consultation with Dr Scionti can determine the best HIFU treament plan for  each patient. The Scionti Prostate Center does not believe in cookie cutter solutions.  A personalized treatment plan is best.

 

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