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High intensity focused ultrasound (HIFU) treatment for prostate cancer

Key points

  • HIFU uses ultrasound energy to destroy cancer cells.
  • HIFU is one treatment option for prostate cancer that hasn't spread outside your prostate.
  • HIFU may be done as a day-case procedure under general or spinal anaesthesia.
  • The procedure normally takes up to three hours.

Pros and cons

  • Pros of HIFU include being able to have the procedure and go home on the same day. It is a less invasive procedure than surgery.
  • Cons of HIFU include lack of information about how effective it is in the long term or how it can affect your everyday life. This is because HIFU is a relatively new treatment.
     

Read more on the pros and cons tab below.

High intensity focused ultrasound (HIFU) is a type of cancer treatment that uses special high intensity ultrasound energy to heat and destroy cancer cells in your prostate.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About HIFU

HIFU treatment uses high intensity ultrasound energy to heat and destroy cancer cells in your prostate gland.

Currently, HIFU is only used in clinical trials for men with localised prostate cancer (cancer that hasn’t spread outside of the prostate). This is because there isn't enough evidence on how well it works to recommend its use in all men with prostate cancer. The National Institute for Health and Care Excellence (NICE) recommends that HIFU is used in clinical trials so that longer term data can be collected.

HIFU is also being investigated in clinical trials in men with prostate cancer that has come back after radiotherapy treatment.

If you have an enlarged prostate and your urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system) recommends you have HIFU, he or she may offer you another type of treatment beforehand to shrink the gland. For example, hormone therapy, or a procedure called transurethral resection of the prostate (TURP).

What are the alternatives to HIFU?

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)

Preparing for HIFU

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.

What happens during HIFU

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.

What to expect afterwards

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.

Recovering from HIFU

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.

What are the risks?

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

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

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.

 

Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, July 2013.

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For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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