VCU Massey Comprehensive Cancer Center has become the first institution in Virginia to offer robotic high-intensity focused ultrasound (HIFU) for prostate cancer treatment, introducing a noninvasive alternative that could transform care for thousands of patients with intermediate-risk disease.
The Focal One HIFU system uses ultrasound waves to precisely destroy cancerous tissue within the prostate without surgery, radiation, or external incisions. According to Dr. Alexander Kenigsberg, director of urologic oncology at VCU Health Massey Comprehensive Cancer Center, the procedure addresses a critical clinical gap in prostate cancer management.
"Some men have disease that is really not very clinically aggressive, but other men, as noted by it being the second leading cause of male cancer death, have very aggressive disease. And then somewhere in between, there is this large pool of men who have something that is not quite the disease that we are comfortable watching, but probably not the really aggressive disease that's going to drive their mortality," Kenigsberg explains.
Procedure Details and Patient Experience
The HIFU procedure is completed as a same-day outpatient treatment under general anesthesia, taking approximately one to one-and-a-half hours. Patients typically return home the same day with minimal recovery time compared to traditional surgical approaches.
"What is great about this procedure is we can see some of the key structures that have to do with erectile function and incontinence and preserve them," Kenigsberg said. The technology allows physicians to target cancerous areas while sparing healthy surrounding tissue and critical anatomical structures.
Clinical Outcomes and Effectiveness
While HIFU represents a paradigm shift from traditional curative approaches, early data suggests promising outcomes for appropriate candidates. Kenigsberg describes focal therapy as "turning an acute condition into a chronic condition," where patients undergo surveillance after treatment to potentially avoid more aggressive interventions.
Clinical data indicates that approximately 25% of patients may require repeat ablation, while 20-30% may progress to surgery or radiation within five years. However, the procedure demonstrates significantly reduced morbidity compared to radical prostatectomy and radiation therapy, with better preservation of erectile and urinary function.
A multi-center study of more than 3,000 patients has demonstrated comparable cancer control to more aggressive treatments while minimizing adverse events such as incontinence and erectile dysfunction that commonly accompany surgery and radiation.
Patient Selection and Monitoring
Ideal candidates for HIFU include patients with MRI-visible disease who have undergone targeted biopsies to confirm the precise location of cancer. The advancement of MRI technology and biopsy techniques has enabled more accurate patient selection and treatment planning.
Post-treatment monitoring involves regular prostate-specific antigen (PSA) testing, with expected reductions of at least 50%. Patients undergo routine MRI surveillance at 6-12 months, with biopsies performed if imaging raises concerns. The center is also exploring prostate-specific membrane antigen (PSMA) PET scans for enhanced monitoring capabilities.
Broader Impact and Accessibility
The introduction of HIFU at VCU Massey represents a significant advancement in treatment accessibility. Unlike early adoption phases where patients traveled internationally and paid tens of thousands of dollars out-of-pocket, the procedure now has standardized billing through CPT codes and coverage from Medicare, VA, and increasing numbers of private insurers.
"There is so much morbidity associated with the standard treatment options that there are a lot of downstream costs associated with surgery and radiation, many of which we will not see with focal ablation," Kenigsberg noted.
Given that prostate cancer affects over 200,000 men annually in the United States and represents the most commonly diagnosed malignancy in men, HIFU could potentially benefit 30-40% of prostate cancer patients as a standard-of-care option for intermediate-risk disease.
Future Research Directions
Long-term studies are needed to evaluate outcomes beyond the current 5-7 year follow-up data, including functional outcomes over 10-25 years and the effects of multiple ablation procedures. Research priorities include optimizing surveillance protocols, defining clinically meaningful recurrence, and determining optimal imaging strategies for patient follow-up.
Kenigsberg emphasizes the importance of rigorous study through organizations like the Focal Therapy Society to ensure appropriate application of the technology and comprehensive outcome tracking for patient benefit.
