High-Intensity Focused Ultrasound Provides Less Invasive Way to Fight Prostate Cancer

St. Clair Health Offers Less Invasive Way to Fight Prostate Cancer

By Andrew Wilson

Ultrasound has long been valued as a diagnostic tool, but a new type of ultrasound – called high-intensity focused ultrasound is being used for the treatment of early-stage prostate cancer at St. Clair Hospital.

“Ultrasound has been used in imaging for a long time, but it’s the high-intensity focused aspect of it that makes it a tool for treatment,” said Kevin Bordeau, M.D., a urologist with St. Clair Medical Group. “It provides us with an option to treat some cancers in a less invasive way.”

Ten to 15 years ago, ultrasound could be used to kill cancer tissue, but in Dr. Bordeau’s view it wasn’t as good an option as surgery was at that time. That has changed for prostate cancer caught in its early stages due to the ability to target specific areas of the prostate gland using advanced MRI and PET scan imaging.

“Treatments change over time and improve,” said Dr. Bordeau. “High-intensity ultrasound is so useful because it’s less invasive so we can eliminate the anxiety that some people have about undergoing surgery.”

A common misperception about prostate cancer many people may have is that the cancer cells encompass the entire prostate gland, but, in the early stages, cancer can begin with just a few small spots surrounded by healthy tissue. In the early stage, these spots may vary greatly in appearance. Some may not look much different than normal cells, while others appear markedly different.

The first step after an elevated PSA test – which measures the amount of prostate-specific antigen in the blood – is to do a biopsy. From the biopsy, a pathologist will assign the spots a Gleason score, which is a measure of the aggressiveness of the cancer. The Gleason score is typically between six and 10, with a six being slower growing and 10 being quite aggressive.

“The perfect candidate for high-intensity focused ultrasound is someone with a slightly higher Gleason score of six or seven or a slightly higher volume of cancer than can safely be watched. It is best when cancer can be seen on the MRI,” said Dr. Bordeau. “It also allows us to treat an older patient who isn’t a good candidate for a more aggressive surgery because of other health issues.”

He explained that the ultrasound procedure begins just like the biopsy, with the patient lying on his side but does require anesthesia. The ultrasound device is inserted into the rectum for the best possible positioning to access the prostate gland. High-intensity focused ultrasound offers more precision, allowing urologists to destroy the cancer cells while preserving as much healthy tissue as possible.

“As we move the ultrasound, we are seeing MRI or PET scan images in real time, so we can pinpoint where the affected area is on the prostate,” Dr. Bordeau explained. “The whole procedure takes about one and a half to two hours. Most of that time is spent mapping out the area for treatment. There is no cutting. The ultrasound pulses travel through the tissue to reach the cancer.”

Because high-intensity focused ultrasound is less invasive, Dr. Bordeau hopes it might encourage more men to be screened. For most men, screening begins in the primary care physician’s office with a digital rectal exam and a PSA test. These typically begin at age 50 but may start earlier if the patient has a family history of prostate cancer.

“Some men are fearful of the treatment options they have about, so they resist getting screened,” he said. “But if they knew there are better treatment options, they might think differently.”

That’s the message that Dr. Bordeau wants to impart to patients: “Our treatment options are getting better and better. High-intensity focused ultrasound gives us another tool in our toolbox to treat cancer less invasively,” he said. “The earlier that we can detect and treat cancer, the better the outcome that’s possible.”

Dr. Kevin Bordeau is board-certified in urology. He earned his medical degree at Tufts University, Medford, Mass., and completed a residency at Eastern Virginia Medical School, Norfolk. Dr. Bordeau was named a Top Doctor by Pittsburgh Magazine as well as one of America's Best Prostate Cancer Surgeons by Newsweek in 2024. He practices with St. Clair Medical Group and sees patients at the Dunlap Family Outpatient Center in Mt. Lebanon. To schedule an appointment with Dr. Bordeau, call (412) 942-4100.