Your surgeon will explain how to prepare for the procedure.
You may have an enema the morning of your procedure. An enema is a liquid that is injected into your rectum (back passage) to empty your bowel.
HIFU is usually done as a day-case procedure under general anaesthesia. This means you will be asleep during the procedure. Alternatively, you may be given a spinal or epidural anaesthetic. This completely blocks pain from your waist down and you will stay awake during the procedure. Your surgeon may also give you a sedative to help you to relax.
If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.
The type of treatment you have for prostate cancer will depend on whether the cancer has spread, and if so, how much. If you're invited to take part in a clinical trial for HIFU, your surgeon will tell you about the other treatment options available. Alternative treatments for prostate cancer include:
- watchful waiting, which involves monitoring the cancer, but not treating it unless it grows
- surgery – a surgeon can remove your prostate using either open or keyhole surgery
- radiotherapy, which uses radiation to destroy cancer cells
- brachytherapy, which involves having small, radioactive seeds put into your prostate
- cryotherapy, which uses liquid gas to freeze and kill cancer cells (only offered in clinical trials in specialist centres in the UK)
HIFU takes up to three hours. However, the exact time your procedure will take depends on the size of your prostate and how much of it is being treated.
Once you have been anaesthetised, your surgeon will pass a lubricated probe into your rectum. The probe will give out a beam of ultrasound. Your surgeon will focus the beam so that it heats and destroys the area of prostate tissue where there is cancer. The probe is guided by precise and sophisticated software to ensure only the desired areas of your prostate are targeted.
You may need to rest until the effects of the anaesthetic have passed. If you had a spinal anaesthetic, it may take several hours before the feeling comes back into your legs. You may need pain relief to help with any discomfort as the anaesthetic wears off.
You will have a catheter (a fine tube) to drain urine from your bladder into a bag. The catheter may pass out through either your penis or through a small cut in your abdomen (tummy). The catheter may be left in place for up to two weeks, but this can vary.
You will usually be able to go home when you feel ready. A nurse will give you some advice about how to manage your catheter at home and may give you an appointment to return to hospital to have it removed. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your procedure.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.
Your surgeon may prescribe a course of antibiotics to help prevent you developing an infection.
If you have been prescribed antibiotics, it's important to complete the full course.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
As with every procedure, there are some risks associated with HIFU. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of HIFU include:
- blood in your urine
- difficulty passing urine once the catheter has been removed (because of swelling in your prostate)
- passing some of the destroyed prostate tissue and blood in your urine (which may be uncomfortable)
Contact the hospital or your GP if you have:
- increasing pain, or pain that you can't control with painkillers
- a high temperature
- increased blood in your urine
- difficulty passing urine
Complications are when problems occur during or after the procedure. The possible complications of HIFU include the following.
- A urinary tract infection – the risk of infection is high for a few weeks. So if you’re prescribed antibiotics, it's important to complete the full course.
- Stress incontinence – the muscles around your urethra (the tube that carries urine) can become weakened. This means you may leak some urine when you cough, sneeze or make a sudden movement.
- Urge incontinence – you may feel you need to pass urine more frequently or more urgently.
- Impotence – you may not be able to get or maintain an erection after HIFU treatment.
- Infertility – your fertility may be affected.
- Damage to your rectum (back passage) – this can cause a burning feeling or bleeding from your rectum.
It’s important to remember that there isn't as much information about all the side-effects and complications of HIFU treatment compared with other treatments so this list may not cover everything. Speak to your surgeon for more information.
This information is intended to help you understand the advantages and disadvantages of high intensity focused ultrasound (HIFU). Think about how important each particular issue is to you. You and your doctor can work together to make a decision that's right for you. Your decision will be based on your doctor’s expert opinion and your personal values and preferences.
- Research shows that HIFU appears to be a successful treatment for prostate cancer.
- HIFU is less invasive than surgery to remove your prostate, which means you may have fewer complications from the treatment.
- You can normally have the procedure and go home the same day.
- There may be less chance of damaging surrounding structures and nerves after HIFU, compared with other treatments, such as surgery and cryotherapy. However, more research is needed to prove this.
- HIFU is a relatively new treatment. This means there isn't a lot of information about how effective it is at treating prostate cancer in the long term, or how it can affect your everyday life.
- The availability of HIFU is limited. This is because it can only be used in the UK as part of a clinical trial comparing HIFU with other standard prostate cancer treatments.
- HIFU isn't an option if your cancer has spread beyond your prostate.
- One possible complication of HIFU is that it can affect your sex life. However, this is rare and only affects around two in a 100 men.
- Research shows that HIFU appears to be a successful treatment for prostate cancer.
Can HIFU treatment affect bladder control?
It's possible that you may have urinary incontinence for two to three months after HIFU treatment.
If you have HIFU treatment, it can cause inflammation and swelling of your urethra (the tube that carries urine from your bladder and out through your penis), and make it difficult for you to pass urine. Because of this you will have a thin tube called a catheter in place for around two weeks after the procedure. The catheter will drain urine from your bladder into a bag.
Having HIFU too close to the neck of your bladder or sphincter (muscle that holds your anus closed), may weaken your bladder or urethral muscles. This means there is a chance you may leak urine when you cough, sneeze or make a sudden movement after the catheter is removed. This is called stress incontinence. You may also feel the need to pass urine more frequently and urgently, which is known as urge incontinence. These symptoms should gradually improve. If you’re having symptoms of either type of incontinence, speak to your surgeon for advice.
Can high intensity focused ultrasound (HIFU) cause impotence?
A potential complication of HIFU treatment for prostate cancer is impotence.
When you have HIFU treatment, ultrasound energy is used to heat and destroy cancer cells in your prostate gland. The ultrasound energy can sometimes damage the nerves and blood vessels that control your erections. This means that you may not be able to get or maintain an erection after your treatment. However, for most men, this isn’t permanent. Permanent impotence happens to about two out of 100 men who are treated with HIFU.
There are treatments available if you have impotence after HIFU treatment. Speak to your GP for more information.
Is it painful to have the catheter removed after HIFU treatment?
You may feel slight discomfort when the catheter is removed.
HIFU treatment for prostate cancer can cause inflammation and swelling of your urethra (the tube that carries urine from your bladder and out through your penis), which can make it difficult to pass urine.
Your surgeon will fit a thin tube called a catheter at the time of your surgery, which will drain urine from your bladder into a bag. The catheter may be passed through the urethra in your penis into your bladder and left in place for around two weeks. Alternatively, your surgeon may place the catheter directly into your bladder through a small cut in your lower abdomen (tummy). This is called a supra-pubic catheter.
You may be given an appointment at the hospital to have your catheter removed. You may feel slight discomfort when the catheter is removed but it shouldn't be painful.
- Prostate Cancer UK
0800 074 8383
- Prostate cancer treatment and management. Medscape. www.emedicine.medscape.com, published 1 July 2013
- High intensity focused ultrasound (HIFU) for prostate cancer. Cancer Research UK. www.cancerresearchuk.org, published 31 July 2012
- Guidelines on prostate cancer. European Association of Urology. www.uroweb.org, published February 2012
- Focal therapy using high intensity focused ultrasound for localised prostate cancer. National Institute for Health and Care Excellence, April 2012. www.nice.org.uk
- High-intensity focused ultrasound for prostate cancer. National Institute for Health and Care Excellence, March 2005. www.nice.org.uk
- Research into treatments for prostate cancer. Cancer Research UK. www.cancerresearchuk.org, published 18 July 2013
- High intensity focused ultrasound (HIFU). Prostate Cancer UK. www.prostatecanceruk.org, published July 2011
- Prostate cancer. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published January 2011
- Localised prostate cancer. Map of Medicine. www.mapofmedicine.com, published 22 April 2013
- Cryotherapy. Prostate Cancer UK. www.prostatecanceruk.org, published July 2012
- Erectile dysfunction. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published January 2013
- Catheter care. Royal College of Nursing. www.rcn.org.uk, published May 2012
- HIFU. Prostate Cancer Foundation of Australia. www.prostate.org.au, published 8 July 2013
- Hummel S, Paisley S, Morgan A, et al. Clinical and cost-effectiveness of new and emerging technologies for early localised prostate cancer: a systematic review. Health Technol Assess 2003; 7(33) www.journalslibrary.nihr.ac.uk
- Li LY, Yang M, Gao X, et al. Prospective comparison of five mediators of the systemic response after high-intensity focused ultrasound and targeted cryoablation for localized prostate cancer. BJU Int 2009; 104:1063–67. doi: 10.1111/j.1464-410X.2009.08481.x
- Prostate Cancer UK
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