Issue link: https://viewer.e-digitaledition.com/i/774678
"HIFU can a lso be used to treat radiation failures," Dr. Gluck says. "Patients who have fa iled either ex terna l bea m radiation or interstitia l radiation with brachy therapy can get a second chance with HIFU. It can a lso be used for patients who failed cryoablation of the prostate and for any patient de novo who has a rectum through which we're able to access the prostate." Patients who may not be idea l candidates include those who have had recta l cancer, or rectal stenosis or abnormalities, some patients with higher-grade cancers, patients who do not have a rectum, or patients who have a severe a llerg y to latex. A lthough Greater Boston Urolog y has o-ces across eastern Massachusetts, Drs. Gluck and Lin perform HIFU procedures at the Eastern Massachusetts Surgery Center in Norwood. Because it is a minimally invasive outpatient procedure, patients can expect to be home the same day of a procedure, which, depending on the size of the prostate, can take any where from an hour and a ha lf to two hours to complete. "Patients are under general anesthesia and are comfortable," Dr. Lin says. "There are no incisions. They do go home with a Foley catheter to help drain urine. That catheter can usua lly be removed within a few days so that patients can urinate norma lly. The next day they can be up and around and do a ll norma l activities. There are no restrictions." HIFU is not currently covered under most insurance plans and, with a $25,000 price tag, it may be out of the fina ncia l reach of most patients. The doctors at Greater Boston Urolog y are hopeful, though, that FDA approva l will quickly lead to coverage through Medicare, which in turn often leads to most major insurance companies covering it. A nd that 's a good thing, as HIFU seemingly has the potentia l to become the go-to treatment for prostate cancer. Fo r m o re info r m at i o n a b o ut H I F U, o r to re fe r a pat i e nt , pl ea s e v i s it www.greaterbostonurology.com or call 617-696-1826. ■ Dr. Gluck in consultation with a prospective HIFU patient 0 8❱❱❱❱❱ C O V E R S T O R Y Fusion-guided Biopsy FOR M A N Y Y E A R S, the standard method for detecting prostate cancer has been the biopsy, and the standard method for taking a biopsy has used ultrasound. The trouble is, ultrasound is not sensitive enough to detect local lesions that may indicate cancer, so Greater Boston Urology has partnered with Shields Health Care Group to develop a better way. UroNav's MRI fusion-guided biopsy system uses the latest technology to pinpoint suspicious areas within the prostate with increased rates of detection of high-risk cancer while reducing the number of needle biopsies and false negatives. "The traditional biopsy method is like pin the tail on the donkey," says Practice Manager Les Cavicchi. "You know you are going to take 12 tissue samples from the prostate, but you don't know if you are going to hit anything. With 3-D fusion, the patient has a MRI first, and this is where the blinders come off. The radiologist will actually segregate that particular image and show us exactly where he's concerned." The MRI fusion-guided biopsy system links the detailed images with the real-time ultra- sound image. "Those lesions seen on the MRI now act as a target so we can do very focused, targeted prostate biopsies that may correlate very well with higher rates of diagnosis," says James Lin, MD, of Greater Boston Urology. "Right now, all we have is a PSA or a prostate nodule that would trigger a prostate biopsy, and we are seeing men who are getting multiple rounds of negative prostate biopsies before a cancer is found. Hopefully, this new technology leads to early detection and better diagnosis and treatment." 0 8