Seven Questions You Must Ask Your Doctor About HIFU

Seven Important questions to ask your doctor BEFORE having HIFU?

1. Is HIFU appropriate for you? Several factors determine your appropriateness for HIFU. Men who are excellent candidates are very likely to have an excellent results. The prostate cancer stage, Gleason Score, extent of cancer, prostate size, volume, and height are ALL critical factors. Extensive calcium deposits can block the ultrasound beam and can make HIFU impossible. An experienced HIFU surgeon can discuss your candidacy in detail.	4. Is a prostate biopsy required having HIFU? There is uniform consensus among HIFU surgeons that the only way to assure that a man has prostate cancer and moreover, that the cancer is appropriate for HIFU treatment is by having a diagnostic biopsy performed that documents that cancer is indeed present and that the Gleason score and extent of disease can be well treated with HIFU. MRI is a valuable tool to assist in performing a targeted or “SMART” biopsy and MRI is a useful tool to “stage” the cancer, but be aware that MRI studies (even with spectroscopy) have a significant false positive rate. This means that in a significant number of cases, MRI or MRI-S can be abnormal and suggest cancer, but when this abnormal region is targeted for biopsy, the result is “prostatitis” and not cancer. Even though HIFU is noninvasive and the side effects are low, it makes no sense (nor is it ethical) to perform a procedure unnecessarily. Be aware of physicians who market their own MRI services and present their own results that have not been subjected to peer review.
2. Is your HIFU doctor Certified by the American Board of Urology? The American Board of Urology is the only entity in America that confers Board Certification in the specialty of Urology. Most American urologists are certified by the American Board of Urology. While this rigorous certification process does not guarantee HIFU competency, it does assure that the urologist has passed extensive examinations, has submitted a practice “log” and had his patterns of urologic care reviewed every 10 years. Board Certification is required by virtually all American hospitals in the granting of staff privileges to a physician. Be aware that Urologists who are not Board Certified often do not have staff privileges at local hospitals and may not be able to offer appropriate post HIFU care.	5. Can your doctor provide the right level of care after HIFU? Post HIFU care and counseling is an important part of the recovery process and essential for obtaining a good result. Even though HIFU is non invasive, the prostate gland has been destroyed by the treatment and recovery is required. Counseling directly face to face, by phone or by email with your HIFU physician will guide you through the recovery process and results in a faster return to normal voiding, with a lower risk of complications. You will require a local physician who can remove your catheter when you are cleared by your HIFU physician for catheter removal. Uncommonly, there are conditions post - HIFU that require treatment by your HIFU physician at a hospital or outpatient surgery center. Be sure to ask your HIFU physician if he/she has staff privileges at these facilities so that you can receive appropriate care. Avoid HIFU physicians who cannot offer you excellent post procedural care and who do not have hospital privileges in the United States.
3. How many HIFU procedures has your doctor performed? While there is no magic number to assure competence, HIFU is a complex and technically demanding procedure. Studies from Europe have demonstrated that highly experienced physicians obtain better results. It is important to note that highly experienced proctors often support physicians in the early stage of their HIFU careers in order to ensure that the patient has a good result. Ask your doctor what his experience level is and whether a proctor will be involved in your procedure?	6. What HIFU machine does your doctor use? There are no head to head comparisons of these machines. The Ablatherm was the first to be used for prostate cancer in France in 1995, while the Sonablate was first used in Japan in 1998. There is published data on both the Sonablate and the Ablatherm procedures. Both machines have undergone significant technical improvements over the years, but the Sonablate 500 has significant technical advantages in the hands of an experienced HIFU surgeon. These are: the ability to modulate power to achieve appropriate tissue response, the ability to measure tissue response (Tissue Change Monitoring), better ability to conform or match the treatment to individual prostate anatomy, 3D coronal plane imaging, and Doppler technology to assist in mapping the location of the neurovascular bundles. It is my opinion that the Sonablate 500 offers an experienced HIFU physician an enhanced ability to customize the treatment for an individual patient’s cancer and prostate anatomy.
	7. Does your doctor follow the Scionti Advanced HIFU Protocol? Dr. Scionti has combined his vast skills and experience in treating hundreds of HIFU patients to develop the Advanced HIFU Protocol. The Scionti Advanced HIFU Protocol is designed to identify which men are excellent HIFU candidates and it goes beyond a standard HIFU treatment by providing patients with a comprehensive approach that integrates components necessary for a successful HIFU procedure: 1) Advanced diagnostic evaluation and planning, 2) Precise conformal treatment and 3) Personalized patient follow up.