Questions to Ask Your HIFU Doctor
- Is your doctor experienced in determining HIFU candidacy?
Several factors determine appropriateness for HIFU. Men who are excellent candidates are very likely to have an excellent result. The prostate cancer stage, Gleason Score, extent and location of cancer, prostate size, volume, and height are ALL critical factors. Extensive calcium deposits can block the ultrasound beam and can make HIFU impossible. Only an experienced HIFU surgeon can best assess your candidacy in detail.
- Is your HIFU doctor Certified by the American Board of Urology?
The American Board of Urology is the only entity in America that confers Board Certification in the specialty of Urology. Most American urologists are certified by the American Board of Urology. While this rigorous certification process does not guarantee HIFU competency, it does assure that the urologist has passed extensive examinations, has submitted a practice “log” and had his patterns of urologic care reviewed every 10 years. Board Certification is required by virtually all American hospitals in the granting of staff privileges to a physician. Be aware that Urologists who are not Board Certified often do not have staff privileges at local hospitals and may not be able to offer appropriate post HIFU care.
- How many HIFU procedures has your doctor performed?
While there is no magic number to assure competence, HIFU is a complex and technically demanding procedure. Studies from Europe have demonstrated that highly experienced physicians obtain better results. It is important to note that highly experienced proctors often support physicians in the early stage of their HIFU careers in order to ensure that the patient has a good result. Ask your doctor about his experience level and whether he/she is still being proctored as part of training. Remember that physician experience is the most important variable in HIFU success.
- Does your doctor claim to diagnose prostate cancer by MRI without a needle biopsy?
There is uniform consensus among HIFU surgeons that the only way to assure that a man has prostate cancer and whether the cancer is appropriate for HIFU treatment is by having a diagnostic biopsy performed. The Scionti Prostate Center utilizes MRI Guided Fusion or SMART biopsy technology. We do not suggest blind, random, prostate biopsy. This process documents the presence of cancer, and reveals if the Gleason score and extent of disease can be well treated with HIFU. While a handful of U.S. physicians have claimed they can diagnose and treat patients without a biopsy, even the best MRI scans on 3T MRI machines simply do not provide the physical evidence needed for a treatment decision. While HIFU is noninvasive and the side effects are low, it makes no clinical or economic sense (nor is it ethical) to perform a procedure unnecessarily. Be aware of physicians who market their own MRI services and present their own “results” that have never been published in peer reviewed journals or admitted as podium presentations before peers.
- Can your doctor provide the right level of care after HIFU?
Post HIFU care and counseling is an important part of the recovery process and essential for obtaining a good result. Even though HIFU is non invasive, the prostate gland has been destroyed by the treatment and recovery is required. Counseling directly face to face, by phone or by email with your HIFU physician will guide you through the recovery process results in a faster return to normal voiding, and a lower risk of complications. You will require a local physician who can remove your catheter when you are cleared by your HIFU physician for catheter removal. Uncommonly, there are conditions after HIFU that require treatment by your HIFU physician at a hospital or outpatient surgery center. Be sure to ask your HIFU physician if he/she has staff privileges at these facilities so that you can receive appropriate care. Avoid HIFU physicians who cannot offer you excellent post procedural care and who do not have hospital privileges in the United States.
- What HIFU machine does your doctor use?
There are no head to head comparisons of these machines. The Ablatherm was the first to be used for prostate cancer in France in 1995, while the Sonablate was first used in Japan in 1999. There is more published data on Ablatherm procedures. Both machines have undergone significant technical improvements over the years, but the Sonablate 500 has significant technical advantages in the hands of an experienced HIFU surgeon. These are: the ability to modulate power to achieve appropriate tissue response, the ability to measure tissue response (Tissue Change Monitoring), better ability to conform or match the treatment to individual prostate anatomy, 3D coronal plane imaging, and Doppler technology to assist in mapping the location of the neurovascular bundles. It is my opinion that the Sonablate offers an experienced HIFU physician an enhanced ability to customize the treatment for an individual patient’s cancer and prostate anatomy.
- Does your doctor follow the Scionti MMM ( Triple M ) HIFU Protocol?
Dr. Scionti has combined his skills and experience in treating over 1000 HIFU patients along with his unique highly defined HIFU techniques to develop the Scionti MMM ( triple M ) HIFU Treatment. The Scionti MMM HIFU Treatment utilizes MRI Mapping and energy Modulation to deliver a higher dose of energy to the most significant region of cancer in the prostate, while minimizing energy to the surrounding tissues. Advanced diagnostic MRI evaluation and planning, precise MMM ( triple M ) HIFU treatment, and in-person or virtual long term follow and monitoring are the hallmarks of the Scionti Prostate Center HIFU program.