Dr. Stephen Scionti is almost certainly the most experienced practitioner of high-intensity focused ultrasound (HIFU) as a first-line treatment for prostate cancer practicing in the USA today — although he has had to actually treat the vast majority of his patients outside of the USA.
On October 12 this year, the U.S. Food and Drug Administration finally approved SonoCare Medical’s Sonablate® 450 technology for the ablation of prostate tissue in the USA after a long and — at least for the developers — frustrating journey. However, this approval of SonoCare’s technology is not without controversy, and the optimal role or roles of HIFU in the management of prostate cancer are still largely unclear because we have almost no published, peer-reviewed data to consult on the use of this technology (or any other form of HIFU) in the treatment of US-based patients.
The available data from European and Australian experience with HIFU in the management of prostate cancer gives many people reasons for considerable caution about the widespread uptake of this form of treatment. On the other hand, there is no doubt that if HIFU can actually be used to achieve the outcomes claimed by some of its more ardent advocates, it will be a highly attractive treatment option for many patients with — at least — low- and intermediate-risk disease.
On November 17, at 5:00 p.m. Eastern, we plan a frank conversation with Dr. Scionti about the short-term and longer-term applications of HIFU in the management of prostate cancer here in the USA, with particular emphasis on such matters as
- The characteristics of the most appropriate patients for treatment
- The risks for side effects and repeat treatments
- The importance of clinician training and experience in achieving high-quality outcomes, and
- When we might expect to be able to see meaningful data on the 5-year follow-up of a large series of US patients treated with HIFU.
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Filed under: Diagnosis, Management, Risk, Treatment | Tagged: CureTalk, focused, high-intensity, Scionti, ultrasound |
THE "NEW" PROSTATE CANCER INFOLINK 
Great timing for this interview!
I have put the date and time on my calendar.
Equipment: Mike, would you also ask about the role that equipment plays, in addition to training and experience? I’m thinking about the Uchida group that did not have impressive results for years, despite using Sonablate 500, but then they achieved what looks like great success with more advanced ablation, imaging and associated technology (referred to as the “tissue change monitor” [TCM] group). This Uchida study was covered in this article. My response of August 16, 2014 at 3:47 pm addressed specific technical advances benefiting the TCM group of patients.
Research Follow-up Time: Would you also inquire about minimum median follow-up time to get a good read on effectiveness against the cancer as well as side effects? My impression is that at least 5 years is needed for HIFU as success at many centers is falling rather rapidly from 3 through 5 years.
My first thoughts are on his position with regard to active surveillance and whether he believes this therapy is a safe alternative to it. I say that because I see a pattern, not necessarily by Scionti, of HIFU doctors telling their patients this. At least one I know says he was trained through Scionti on the technique.
The Program with Dr. Scionti This Late Afternoon
First, thanks moderator, Mike and panel; nice work!
I was glad that Dr. Scionti was quite familiar with the details of the technology in the Uchida group’s apparently successful use of HIFU, referred to as the TCM or Tissue Control Monitor technology, but actually more than that. Not only was he familiar with the technology but he explained the related roles and histories of each piece of technology. That suggests to me that he now also takes advantage of these specific advances — TCM, the retracking feature, the size of each treatment lesion, and one he added that he does use enthusiastically, MRI. Can anyone confirm that?
I was impressed that he did not make great claims for the success of HIFU against prostate cancer, in sharp contrast to the content of some of the HIFU advocacy web sites. I’m wondering if that might have been because he was aware he was dealing with a savvy group, or if that’s the way he normally operates.
It was reassuring that he encourages low-risk patients to go on active surveillance.
I found it understandable but disappointing that, except for the approximately 90 patients getting focal HIFU therapy (thanks Mike), he has not tracked his patients in a systematic way, such as something approximating a series of consecutive patients as is done in many clinical series. I’m left with the strong impression that he does not know what level of success he himself is achieving. He did comment that there are no commitments by insurers yet, after the recent FDA limited approval, and he noted that insurers will want to see outcome data. As he suggested, with the FDA approval, it should be much easier to establish reliable sites and protocols so that result information can be collected.
Dr. Scionti mentioned at least three other research leaders other than Dr. Uchida. One was Dr. Crouzet, one was Dr. Mark Emberton, and I did not catch the third. The PubMed results for Dr. Crouzet did not indicate success competitive with radiation or surgery, and results from Dr. Emberton’s team that I found were quite premature for an assessment of effectiveness.
At this point, for me the jury is still out, but I was glad to hear Dr. Scionti’s expert leader impression of the state of play.