Three patients entered a new era of prostate cancer treatment, as Keck Medicine of USC became the first academic medical center in the nation to use new energy-based robotic ablative technology in an outpatient procedure for prostate cancer.

USC Institute of Urology surgeons used a Food and Drug Administration-cleared noninvasive high-intensity focused ultrasound (HIFU) surgical ablation system to destroy prostate tumors in three patients. The system enables surgeons to introduce the HIFU system into the patient’s body through the rectum to treat localized tumors in the prostate gland.

Inderbir Gill, founding executive director of the USC Institute of Urology, and professor in the Catherine and Joseph Aresty Department of Urology at the Keck School of Medicine of USC, performed the surgery on two patients on Dec. 10 and one more on Dec. 11. Two patients were discharged the same day and the third patient went home the next morning, which is sooner than patients typically experience with prostate cancer surgery.

This is a noninvasive, nonsurgical, outpatient procedure that does not involve any radiation.

Inderbir Gill

“The goal of focal HIFU is to target and destroy only the significant cancer lesion, thereby preserving the delicate nerves around the prostate, thus protecting both continence and potency,” Gill said. “This is a noninvasive, nonsurgical, outpatient procedure that does not involve any radiation. There is no blood loss, the recovery is quick and typically the patient is back on his feet and discharged the same day.”

Older men at risk

Prostate cancer is the second leading cause of death among American men, behind lung cancer. It is diagnosed most frequently in older men. The American Cancer Society estimated that 220,000 men would be diagnosed with prostate cancer and nearly 28,000 patients would die from the disease in the United States in 2015.

According to Gill, HIFU surgery is an option for patients who have low- to intermediate-risk cancer, with localized lesions within a prostate that is no more than 40 grams in volume, and who already possess strong levels of continence and potency. In general, patients should have organ-confined disease and a prostate-specific antigen (PSA) level under 15-20 ng/ml.

Brett Lindsay, 46, of Scottsdale, Ariz., was the first of Gill’s patients to receive this form of treatment. As a regional vice president for Clean Energy Fuels and a strong advocate for the environment, Lindsay maintains a rigorous travel schedule, helping organizations transition their mass transit vehicles from traditional fuels to clean energy.

Back to the greens

“I was anxious to find a form of treatment that would remove my cancer, but still allow me to get back on the road with minimal down time,” Lindsay said. “With HIFU I can continue working with my team and still have the energy to get in a few rounds of golf on the weekends.”

Lindsay actually scheduled a business trip that began five days after his surgery.

Currently, HIFU systems developed by two manufacturers, EDAP TMS and SonaCare Medical, have been granted FDA clearance. The USC Institute of Urology is the first and only center in the United States to offer both technologies, which collectively cover the entire range of HIFU treatments.

Patients are given general anesthetic and the HIFU probe is introduced into the rectum. The ultrasound beam is aimed at the prostate through the rectum, destroying the tumor noninvasively and precisely, with a flash of heat.

In addition to offering prostate cancer patients personalized, targeted care that can maintain their quality of life, Gill said he is looking forward to performing novel molecular and imaging research on HIFU-treated prostate and renal cancers to further advance this emerging field.

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