Urologic oncologist Dr. Edward Uchio with Focal One patient Jeff Nelson.
Prostate cancer runs in Jeff Nelson’s family. His brother, uncle and cousins have all been diagnosed with the disease. When his prostate-specific antigen (PSA) test results jumped to 5.5 from 4 in summer 2018, he knew he had to move quickly.
The retired commercial banker’s research led him to UCI Health and prostate cancer specialist Edward M. Uchio, MD, who recommended an investigative technique called MRI fusion biopsy, which showed that Nelson did have prostate cancer on the right side.
Uchio and Nelson discussed his options, which included an ablative procedure that uses high-intensity, focused ultrasound (HIFU) beams to destroy the tumor.
No needles or scalpels
Nelson chose the Focal One treatment because it required no needles or scalpels and more precisely targeted the cancerous tissue. With Nelson's procedure in February 2019, UCI Medical Center became the first U.S. hospital to use the Focal One ultrasound system, which was developed by EDAP TMS.
Nelson was delighted with the outcome, not least because he was able to go home the same day. “Other than dealing with a catheter for a week, I felt great!” recalls the 65-year-old Tustin resident, who trains in martial arts and hikes extensively.
“This recent advance in prostate cancer treatment allows for incredibly accurate targeting and destruction of cancerous tissue while sparing healthy tissue and the surrounding structure of the prostate,” says Uchio, director of urologic oncology for UCI Health.
A safer way?
Traditional treatment methods for prostate cancer include active surveillance — closely watching the disease — or proactive intervention with surgery or radiation. Robot-assisted radical prostatectomy, cryoablation, radiation therapy and other minimally invasive therapies are among leading treatments for the disease and are UCI Health specialties.
Still, these approaches carry risks and benefits. Uchio says focal HIFU technology may offer a safer way.
The system’s imaging capabilities allow urologists to view 3D images on a large monitor during the procedure, training the ultrasound waves only on the cancerous areas of the prostate. The technology is expected to lower potential side effects, such as sexual dysfunction and incontinence that may accompany more invasive treatments.
“This procedure can preserve the patient’s quality of life,” says Uchio, the Jerry D. Choate Chair in Urologic Oncology in the UCI School of Medicine’s Department of Urology.
PSA tests a must
Nelson now encourages friends and acquaintances to get their PSA levels checked regularly. He also attends the annual Orange County “Cruising for a Cure” charity car show, which benefits prostate cancer. Attendees can get their blood drawn to check PSA levels.
“It’s so critical to have your PSA tested,” he says. “I had no symptoms and that is what is so tricky about prostate cancer.”
If PSA levels are higher than 4, which is considered normal, Nelson advises men to do as much research as they can.
“Don’t be afraid of the tests and biopsies,” he says. ”Get the results and find out where you’re at. If you catch this early enough, you’ll have more options like I did with Focal One, versus having your entire prostate removed.”
A promising approach
Although physicians have seen promising results with Focal One, Uchio said no long-term data yet exists about the impact of the technology.
“It will likely take many years to establish HIFU therapy as a standard treatment option,” he said, adding that the therapy may not be appropriate for all men diagnosed with prostate cancer. “Still, we see it as an obligation to examine all treatment options, including new technology, to improve the standard of care for our patients."
It's too soon to determine how effective the Focal One treatment has been, Nelson says. "Dr. Uchio will re-biopsy the suspect area in eight or nine months to check for any signs of cancer. In the meantime, we will keep tabs on my PSA levels. When I went in for the procedure, my PSA had jumped to 7.3. We just tested it again recently and it was down to 6.1, so that's good. He said I shouldn't expect my levels to go to zero because I still have much of my prostate."
Nelson anxiously awaits the day Uchio can say definitively that there is no sign of cancer.
"I understand how this works and it may be a year before he can state that," he says. "But I feel great and I have had no lasting side effects."