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By Dr. Brian J. Miles                    Follow East Palo Alto Today on
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October 12, 2017                     EPA Today Facebook page Follow epatoday on Twitter EPA Today Blog Icon


Dr. Brian J. Miles
Brian J. Miles, MD


African American men who delay testing or treatment for prostate cancer run greater risks with their health than other males -- because they are roughly 1.6 times more likely to develop the disease than white men, and also more than twice as likely to die from it than whites.

In light of those statistics, a recent study in Cancer, a peer-reviewed journal of the American Cancer Society (ACS) recommends that black men should be screened for prostate cancer more often and at a younger age. The study is significant because it challenges the conventional wisdom that early screening of typically slow-growing prostate cancer can lead to over-treatment.

The recommendations of the ACS study may get a needed boost from a relatively new ultrasound treatment procedure known as HIFU.

HIFU (which stands for High Intensity Focused Ultrasound) is a minimally invasive procedure for ablating (removing) prostate tissue -- minimizing the dreaded side effects of impotence and incontinence.

For the vast number of men diagnosed with localized prostate cancer (that has not metastasized), HIFU ablation may be a more appealing option than the choices these patients have had in the past.  For decades, doctors have offered prostate cancer patients two choices: radiation therapy or radical surgery to remove the entire prostate, which can cause life-altering side effects.  More recently over the past decade, men with less aggressive disease have had the option to choose active surveillance, but with the risk of there being progression of the cancer.

HIFU fills a significant void between active surveillance, which can be stressful and radical whole gland ablation.  HIFU bridges the gap and allows patients to maintain their quality of life.

Older African-American men who are not candidates for prostate cancer surgery could possibly benefit from HIFU. And younger African-American men who are susceptible to the disease may be willing to get tested earlier if they know they have the HIFU option, which may enable them to avoid the impotence or incontinence that can result from prostate surgery or radiotherapy.

HIFU works by directing high-frequency sound waves that heat up and burn off a target area within the prostate. In 2015, the FDA cleared HIFU for prostate tissue ablation.

In addition to the use of HIFU at the University of Chicago Medicine, urologists at Duke University, Cleveland Clinic, Houston Methodist Hospital, University of Miami Miller School of Medicine, USC and Weill Cornell Medicine, (among other hospitals/medical centers) are increasingly using HIFU. According to the Urology Care Foundation, more than 90% of men who are told they have prostate cancer, have localized disease, meaning a majority of these patients could benefit from a minimally invasive procedure like HIFU.

Notably this summer, the US Centers for Medicare and Medicaid Services (CMS) recognized the HIFU procedure and created a specific billing code for partial reimbursement for Medicare patients who choose the HIFU option.

In Europe and around the world, HIFU has been used to treat more than 45,000 patients with encouraging results in terms of both survival rates and quality of life. For instance, a multicenter study conducted by the French Association of Urology (AFU) showed optimal preservation of continence for 97 percent of patients and erectile function for more than 78 percent of men.

As these European studies have shown so far, ablation with HIFU has achieved a good result with minimal side effects.

HIFU is a step in the right direction for patients.

To learn more about prostate ablation and HIFU go to www.hifu-prostate.com. To see the full cancer study, go to http://newsroom.wiley.com/press-release/cancer/higher-prostate-cancer-risks-black-men-may-warrant-new-approach-screening


Dr. Brian J. Miles is a professor of urology at the Institute for Academic Medicine and is associated with Houston Methodist Urology Associates, Houston Methodist and the Weill Cornell Medical College.