Thorough discussion and review of your treatment plan will take place with Dr. Scionti prior to your procedure.
Before HIFU: Preparation for HIFU begins with 36 hours prior to treatment. My patients begin a clear liquid diet on the morning prior to their treatment. The administration of 2 FLEETS enemas two hours prior to the procedure ensures that the rectal cavity is clean and free of any debris that can block passage of the sound waves into the prostate gland. An antibiotic pill is prescribed to begin on the evening prior to the treatment.
During HIFU: Precision HIFU treatment requires that the patient be absolutely still. Therefore, a general anesthetic is administered during the procedure. A catheter will be inserted into the urethra. I will insert a small probe (HIFU transducer) into the rectum that sends ultrasound waves directly through the rectal wall and into the prostatic tissue. During the procedure, the HIFU device delivers real-time images of your prostate and the surrounding area giving me immediate and detailed feedback. Treatment time varies, but generally the procedure lasts a few hours, depending on the size of the prostate. The new TCM (tissue change monitoring) software allows me to determine the effectiveness of each HIFU pulse in order to ensure that the targeted tissue was successfully treated. MRI image guidance is a new technique that permits precise tumor localization and enhanced delivery of energy to the tumor. This proprietary technique is called the Scionti MMM technique ( MRI Mapped Energy Modulated).
After HIFU: Immediately after HIFU procedure most patients typically spend one to two hours recovering at the treatment facility and then are discharged. At that time I will prescribe some basic medications, but most patients do not experience any pain after the procedure. You will be discharged with the catheter in place as it will be necessary to ensure that the bladder empties properly in the early post HIFU recovery. This catheter will remain in place anywhere from a 3 - 10 days. The catheter time is based on the extent of your HIFU treatment and the size of your prostate. In cases of targeted focal treatment, the catheter is only needed for a few days.
Post HIFU care: You will be in close with my HIFU care team during the initial recovery phase. If you live a significant distance from Sarasota, you will be speaking with my HIFU Care team every few days until your catheter is out and you are voiding well. If you are local to Sarasota, you will be followed very closely in my office. You will have your first PSA blood test at 3 months post procedure. This 3 month PSA test represents your new baseline or nadir (low point) level and I will ask you to get your PSA every 3 months in year 1 post HIFU and every 6 months thereafter. If you live at a significant distance from Sarasota, it would be ideal to see me personally for a visit at the time of your 1-year anniversary post HIFU. Current standards of medical practice require you to visit my office annually in order for me to properly monitor your progress and provide ongoing care.
Potential Side Effects and Complications
All treatments for prostate cancer carry some risk for potential side effects and complications. Side effects include frequency, urgency, mild discomfort or discharge in urinary stream or urinary infection in the first few weeks after HIFU. Studies performed outside the US report that less common side effects (these may be more severe) may also include urinary stricture (scar formation in the urinary channel), urinary retention, incontinence (1 – 1.5%), impotence (up to 25% risk) and rectal fistula (very rare: less than 0.5%). Focal or partial gland treatments carry a lower risk of side effects if you are a candidate for that type of HIFU treatment. As with any medical procedure, all potential side effects and complications should be discussed with your HIFU physician before undergoing therapy. As with all treatments for prostate cancer, recurrence is possible and is related to the severity or extent of your prostate cancer.
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