Marc Laniado MD FRCS(Urol) FEBU
CONSULTANT IN UROLOGY

Table of Contents

1. What is HIFU?
2. Why choose HIFU?
3. How is HIFU performed?
4. What to expect after treatment?
5. What are the side-effects of HIFU?
6. How well does HIFU treat the cancer?
7. What do other doctors think about HIFU?
8. What are the alternatives to HIFU?

What is HIFU?

High Intensity Focused Ultrasound (HIFU) is the name for a technique to treat prostate cancer. Like a magnifying glass focuses light rays to a focal point, HIFU concentrates sound waves on a precisely targeted, tiny area of diseased tissue. HIFU heats the tissue to about 100°C degrees and destroys it. 

The advantage of visually Directed HIFU over conventional HIFU is that the surgeon uses real-time feedback to adjust the amount of energy needed to ensure eradication of the diseased tissue whilst protecting healthy tissues. The active involvement of the surgeon in the planning and treatment achieves a higher rate of success.

HIFU is a relatively new treatment that has become popular as it is minimally invasive with few side effects.

To download a PDF on HIFU for prostate cancer, please click the link below:
Patient information on HIFU for prostate cancer

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Why choose prostate HIFU?

There are multiple advantages to this form of therapy:

• short hospital stay and reduced chance of hospital acquired infections such as MRSA
• Quick return to normal activities
• No or minimal discomfort
• low or no blood loss and no need for a blood transfusion
• No cuts, no incisions
• Minimal tiredness after treatment compared to other minimally invasive procedures
• No radiation and its associated short and long term problems
• Good chance of preserving erections
• Option to repeat HIFU after treatment or have alternative treatment after

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How is HIFU performed?

The HIFU procedure is performed in a hospital. Patients stay in hospital just for the day or sometimes the day and overnight. Under a general anaesthetic or epidural block, an ultrasound probe is placed in the rectum (back passage). This probe emits a beam of high intensity ultrasound that kills the prostate cancer cells by heating them to 85 to 100°C. The prostate swells during this procedure so  catheter, which is a plastic tube, is placed to allow easy drainage of urine from the bladder.

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What to expect afterwards?

After waking up from the treatment, there will be a catheter in place. Usually, it is possible to return home in the evening or the following morning. There is minimal discomfort, but pain killers such as paracetamol are usually necessary. Antibiotics are necessary for 2 weeks afterwards.

The catheter stays in place in for 7 to 14 days. After the catheter is removed, you may have to pass urine more frequently during the day and get up during night. There may be an urgent desire to pass urine from time to time. These symptoms resolve over a month or so.

Over the first few weeks, slough i.e. parts of the prostate that have been destroyed by HIFU may be passed in the urine. Depending on the size, the urinary flow may be slowed down and occasionally stop altogether.

Sometimes, there may be blood in the urine, but this is transient and resolves usually with drinking more fluid.

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What are the side effects of HIFU?

As mentioned above, you have have to pass urine more frequently during the day and get up more at night for a few weeks. The flow of urine may be interrupted by 'slough', which is treated prostate tissue that passes into the urine. Occasionally, it may not be possible to pass urine at all and a catheter may need to be put back for a short period of time.

Some men (10 to 25%) develop a narrow area in their urethra, which can restrict the flow of urine. This is a known as a 'stricture', but is usually treated easily.

About half the men who have erections before the procedure still have erections after HIFU. If erections are not present, then they may return with drugs like sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra).

About 2% of men experience may leak a little urine afterwards. This does not usually require pads or changes of underwear. Corrective surgery is not required for this.

One or two men in one hundred may have damage to the rectum (back passage). This can result in an abnormal connection between urethra and rectum, which is called a fistula. Corrective surgery is required for this. This does not usually happen providing there has been no prior treatment such as radiotherapy.

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How well does HIFU treat the cancer?

As HIFU is a relatively new treatment, its efficacy is judged by taking biopsies from the prostate again after treatment and determining how low the PSA drops after treatment. To date, the available data show that PSA levels fall below 0.07 ng/ml in over half the patients, which usually indicates that no further treatment is required.

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What do other doctors think about HIFU?

The National Institute of Clinical Excellence (NICE) has assessed HIFU and indicated that it may be performed providing patients recognise it is a pioneering new treatment. The advantages it has as a minimally invasive treatment needs to be balanced against the absence of long-term data. When reading this document, it is important to remember that Ablatherm system for HIFU was used and not the Sonablate 500 system. I use the Sonablate system because there is good reason as it is possible to visually direct the treatment, which is not possible with the HIFU system. As such the PSA falls after treatment with the Sonablate 500 are far greater. The NICE document can be downloaded here:

• NICE advice to patients considering HIFU for prostate cancer

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What are the alternatives to HIFU?

The alternatives are other minimally invasive techniques including:

• brachytherapy

• cryotherapy

More radical interventions include:

• radical prostatectomy

• external beam radiotherapy

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