Share Recent Experiences with HIFU SBRT and Medicare

Both treatments are covered by Medicare.

My brother had five sessions of SBRT on his prostate three years ago and he’s doing great.

I know at least a dozen other people that had SBRT and it was quite successful. Your Particular case looks mild enough that it should work.

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

Here’s a lot of information on HIFU and other focal therapy

Below our slides from a UCSF meeting where they discussed using HIFU And the issues involved with it. As you know it about 50% of the people needed further the treatment.

Focal Therapy issues
https://howardwolinsky.substack.com/p/focal-therapy-in-the-spotlight-landmark
Here is the full UK article
https://www.sciencedirect.com/science/article/pii/S030228382602169X
At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH Urologic Oncologist UCSF

What about focal therapy?
* The energy modality matters much less than the accuracy of the imaging - which is not there yet.
* Overall focal therapy is associated with minor side effects, but high rates of recurrence both in- and out-of-field.
* Focal therapy is not really a replacement for surgery or radiation; it is better considered an adjunct to active surveillance.

Af the UCSF prostate cancer forum on 4-17-26 Dr. Cooperberg had slides with this information

UCSF Results: first 135 HIFU patients

• 54% recurrence (41% in-field)

• 4% progression by 1 year, 16% overall

• IPSS (urinary obstruction) 6 before, 6 after

• SHIM (erection function) 16 before, 13 after (p=0.11)

• Major drivers of recurrence: GG3, high Decipher

Trade-offs

• Overall focal therapy is associated with minor side effects, but high rates of recurrence

• Inadequate energy delivery?

• Inadequate field of treatment?

• New cancer development?

• Others?

• Understanding the high recurrence rates and trying to improve them is a major area of research focus.

• Focal therapy does not burn bridges: RP, RT, even additional focal therapy are possible if necessary

Summary thoughts

•Focal ablation has a growing role for very carefully selected cases.

• Side effects rates are low but recurrence rates are high. GG3 and high Decipher are warning signs, as are high PSAD and bilateral disease.

• Focal therapy is an adjunct to active surveillance; additional treatment may well be needed down the road, but these treatments are still possible after focal.

University of California Consensus

1 Focal therapy must be acknowledged to be investigational

2. Focal therapy should be done under trial or research protocols as much as possible

3. Candidates should have at least 10 year life expectancy, GG2 or low-volume GG3, stage T1 or 2, and PSA < 10 or PSA < 20 and PSAD
< 0.15

4. Candidates need an MRI-guided confirmatory biopsy before treatment

5. Follow-up biopsy at 12 months is essential

Thanks very much. All great information. And to answer your question about additional biopsy findings, yes on Seminal vesicle invasion, negative on cribriform, etc.

@jeffmarc
Jeff, does that UCSF data include Tulsa? I don’t think they do it. Everything I have seen on early results for Tulsa looks much better than the numbers above.

@jcf58
At this time UCSF does not do Tulsa. From what I’ve heard they only have HIFU. They discussed this at the latest patient conference.

From an observational standpoint, it seems logical that HIFU would not have the success rate Tulsa has. Given that Tulsa is done in a real time MRI environment where margins and temperature are monitored in real time. Time will tell. Thx for clarifying.