Hao G. Nguyen, MD, PhD

Hao G. Nguyen, MD, PhD, Associate Professor of Urology at the University of California, San Francisco, reviews high intensity focused ultrasound (HIFU) for prostate cancer, discussing its basic principles, historical development, current role, and outcomes. He begins by describing HIFU as a non-invasive approach that uses precisely delivered ultrasound energy to a deep tumor necrosis while minimizing side effects, specifying that its success depends on careful patient selection and lifetime surveillance. Dr. Nguyen outlines the history of HIFU from the first prostate cancer treatment with HIFU at Lyon University Hospital in 1993, through 2022. He reviews the NCCN, AUA/ASTRO/SUO, EAU, and DGUS3 guidelines, all of which suggest that HIFU is an option for prostate cancer treatment, but not yet standard care. Dr. Nguyen discusses how focal therapy can work to fill an important treatment gap in prostate cancer, between active surveillance and radical therapy, due to the oncological control with minimal side effects that HIFU provides. He summarizes data on upgrade-free survival during active surveillance that found high rates of overall survival, prostate cancer specific survival and metastases-free survival. Dr. Nguyen also considers data on the role of focal therapy in active surveillance which demonstrates that 70% of FT candidates remain favorable for hemiablation based on biopsy. He then discusses four ways that HIFU can fail: the heat-sink effect wherein cancer vessels wash heat in or away; the margin effect which signals a missed satellite cancer area; the staging effect wherein micromets or clinically significant cancer is missed; and the field effect which is the progression of low-risk cancer or a pre-cancerous area. Dr. Nguyen concludes that HIFU has promising oncological data and could be shown to be an effective option for patients who don’t want active surveillance or radical therapy.