Dr. Scionti has combined over 13 years of HIFU experience in over 1500 patients and is considered America's most experienced HIFU doctor. With his experience in MRI image interpretation gained while on faculty at NYU, Dr. Scionti has developed and refined an Advanced HIFU Protocol: The Scionti MMM (Triple M) HIFU technique. This proprietary protocol is designed to go well beyond standard HIFU treatment by providing patients with a comprehensive approach that integrates four components necessary for a successful HIFU procedure:
1) MRI imaging
2) Tumor Mapping
3) Energy Modulation
4) Dose Escalation
MRI imaging and Prostate Tumor Mapping
Standard prostate cancer diagnosis by TRUS (trans rectal ultrasound) guided biopsy is not accurate. Although used by over 90% of urologists, random or blind TRUS biopsy alone cannot precisely identify the extent or location of tumor within the prostate gland.
MRI, ideally, before prostate biopsy, or 6 - 8 weeks after prostate biopsy, provides 3D tumor volume and tumor location information. If MRI is done prior to biopsy, then the MRI can be combined or fused to ultrasound images to allow for a targeted biopsy . See the discussion about Artemis Fusion biopsy Artemis MRI Fusion Guided Biopsy at Scionti Prostate Center
Additionally, a Power Doppler 3D Ultrasound Scan done at the Scionti Prostate Center can map the prostate size, shape, density, presence of calcium stones, location of the neurovascular bundles and confirm staging. A face-to-face consultation with Dr. Scionti at the Scionti Prostate Cancer Center in Sarasota is highly recommended.
Energy Modulation and Dose Escalation
MRI images and mapped biopsy information is used to create a 3D model of the prostate that reveals the size and location of the tumor in the prostate. This model, created with highly advanced software, is then loaded into the HIFU machine and superimposed, or fused, precisely onto the 3D ultrasound images acquired by the HIFU machine. This results in a 3 D prostate map with prostate contours, prostate structures and tumor location shown on the HIFU treatment planning screen. This advanced technique allows Dr Scionti to modulate energy dosage: This means that energy can be significantly increased over the tumor region and minimized over neighboring important structures. The goal of this sophisticated approach is to get better ablation of the tumor with less side effects.
Dr Scionti will personalize your HIFU treatment
In Summary, the Scionti MMM (Triple M) advanced precision HIFU treatment uses advanced MRI imaging to provide information about prostate size, shape, tissue density, tumor volume, tumor location and mapping of sensitive quality of life structures. To ensure effective treatment, HIFU energy is modulated based on prostate tumor location and severity. Lastly, to help maintain the patient’s quality of life, I carefully control the HIFU energy near critical quality-of-life structures including the nerve bundles to help preserve potency and the urethral apex to help reduce the risk of a urethral stricture. Similar to other prostate cancer treatments, physician experience is the most important factor in treatment success.
FOLLOW UP – Personalized Follow up Care and prostate cancer monitoring program
Monitoring recovery and response to prostate cancer treatment is important with ANY prostate cancer treatment. Many US urologists have very little experience in caring for men who have had HIFU. The PSA levels and MRI images after HIFU are unique and most be interpreted by a physician who understands what is expected and normal and where cancer recurrence may be occurring. Therefore, Dr Scionti has established a prostate cancer follow up program that includes periodic PSA monitoring, periodic MRI study, Targeted Fusion Biopsy if needed, and dietary and supplement guidance. This follow up prostate cancer monitoring program is available on site at the Scionti Prostate Center or as a subscription based virtual telemedicine program for patients who are not local to Sarasota, Fl.