![]() Most importantly, you need to target well so patients can’t be moving. We did do the procedures under continuous spinal anesthesia about 15 years ago. Yes, they need to be asleep and motionless. Are your patients asleep during the procedure? Similar to cryotherapy, the actual response is multimodal, but primarily thermal-created coagulative necrosis. There are also secondary effects including mechanical disruption and immunologic responses. Our target tissue temperature runs in the low 90s centigrade. The focused sound energy creates thermal coagulation-coagulative necrosis. Most of the HIFU machines use a piezoelectric crystal to create amplified sound waves that are then targeted at a focal point. The energy wave must pass through a medium, which is the human tissue. The “U” in HIFU stands for ultrasound, meaning therapeutic sound waves, which are basically higher-power diagnostic sound waves. What weren’t we offering our patients that they would get on a jet and fly to another country to pursue an alternative treatment? What actually is prostate HIFU energy, and how is it delivered? Secondly, I should consider the technology’s advantages because men were opting out of robotic prostatectomies, brachytherapies, cryotherapies, and IMRT. In 2004, when I encountered the first of these men, I decided that if people from my part of the country were going to Europe to get treated, I needed to understand HIFU so I could care for them. Their urologists were not comfortable taking care of them after they were treated in Europe. They weren’t patients I was treating primarily they were returning to the area. Within a few years I began seeing patients who would make appointments for their HIFU follow-up. That trial never expanded, so none of the men in my part of the country were able to participate locally. We were referring patients to Washington, DC if they were interested. In the late 1990s, a number of the academic centers here in the southeast were considering joining an Ablatherm trial, which was the only HIFU trial available at the time. Please describe your experience with HIFU. Brantley Thrasher, MD, executive director of the American Board of Urology. He was interviewed by Urology Times® Editorial Consultant J. ![]() Peretsman is with Urology Specialists of the Carolinas in Charlotte, North Carolina. In this interview, Peretsman discusses which prostate cancers can be treated and which prostate glands can be treated with HIFU, contraindications to the treatment, and what expectations patients need to have postoperatively. ![]() This prompted Peretsman to investigate and ultimately incorporate HIFU into his own practice. Peretsman, MD, began noticing a new group of patients in his practice: men following up after being treated abroad with high-intensity focused ultrasound (HIFU). ![]()
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