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Mar 26, 2018
Major US insurer to cover use of HIFU for treatment of radiorecurrent prostate cancer


Major US insurer to cover use of HIFU for treatment of radiorecurrent prostate cancer

According to a media release issued on March 18 by EDAP TMS, the US healthcare insurance firm CIGNA has agreed to cover the use of high-intensity focal ultrasound (HIFU) as a second-line, salvage therapy for men with radiorecurrent prostate cancer.

Specifically, to quote the media release from EDAP TMS:

The CIGNA policy aligns with National Comprehensive Cancer Network (NCCN) guidelines recognizing that some men with localized prostate cancer may benefit from salvage HIFU.

The policy acknowledges HIFU as “medically necessary as a local treatment for recurrent prostate cancer following radiation therapy” for patients meeting specific medical criteria.

HIFU works by directing high-frequency sound waves that heat up and burn off the targeted area of the prostate.  In 2015, the FDA cleared HIFU for prostate tissue ablation. Because no radiation is involved HIFU is considered a “repeatable technology,” which means that unlike conventional radiotherapy or surgical treatments patients can repeat the HIFU procedure if necessary.

Typically performed in an outpatient setting, HIFU therapy is non-invasive, and according to the CIGNA policy it “remains unique compared with other modalities for localized prostate cancer in that it has been proposed to result in much less adjacent tissue damage.”

The CIGNA policy covers HIFU as a salvage therapy for patients whose early stage prostate cancer has not metastasized and who meet both of these criteria:

Positive, recent (i.e., repeat) transrectal ultrasound guided (TRUS) biopsy completed due to suspicion of local recurrence of prostate cancer
Candidate for local therapy alone as evidenced by ALL of the following:Original clinical stage T1-T2, NX or N0
Recent PSA (Prostate Specific Antigen) of less than 10 ng/mL
Absence of distant metastases

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