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High intensity focused ultrasound (HIFU) for prostate cancer


Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
Next review due July 2021

High intensity focused ultrasound (HIFU) is a treatment that uses high energy sound waves to heat and destroy cells. It can be used to treat different types of cancer, including bladder, kidney, liver and pancreatic cancers. Here we tell you about HIFU treatment for localised prostate cancer. Not all NHS trusts offer this treatment yet because it is still part of ongoing research, although it’s becoming more widely used.

An image showing a man looking out of the window

Who can have HIFU for prostate cancer?

HIFU is becoming more widely available as a treatment for prostate cancer, but only as part of clinical trials. This is because data on the effectiveness of this treatment is still being collected and monitored. Your doctor will be able to tell you if HIFU treatment is available for you to have. You’re also only able to have it if your cancer hasn’t spread outside your prostate.

Deciding on HIFU for prostate cancer

It’s important to discuss the pros and cons of this treatment with your surgeon or cancer specialist (oncologist). Although research shows that HIFU may be a useful treatment for early prostate cancer, these are early studies and we don’t yet know how well the treatment works long term. We need more research comparing HIFU to current treatments before it can be more widely used.

HIFU aims is to be less invasive (ie, it doesn’t involve needles or the need to cut your skin) and less toxic than some other treatments for cancer. Because of this, side-effects may be less likely. However, there’s still a chance that you may have some, so it’s important to know about the potential side-effects and risks of HIFU. See our information further down the page on the side-effects and complications of this treatment.

A positive aspect of HIFU is that you can usually go home the same day that you have the procedure.

As with any type of surgery or treatment, before making a decision whether to have it or not:

  • ask your surgeon or oncologist to explain the potential side-effects of HIFU and what the risk of these are to you
  • ask about whether there are any other treatment options available besides HIFU

Preparing for HIFU for prostate cancer

Before the procedure

Before you have HIFU, you will have an MRI scan and biopsies taken. This is to find out exactly where the cancer is in your prostate. It helps to make sure that only the area with the cancer is treated.

To have biopsies taken, you have an ultrasound probe put into your rectum (back passage). This is so the surgeon can see where to take the biopsies from. After having a local anaesthetic, the doctor will take small samples of tissue from your prostate by putting a needle through the wall of your rectum.

If your prostate is enlarged, you may need another treatment to make it smaller before having HIFU. You may have hormone therapy, which helps shrink your prostate gland. Or you may have transurethral resection of the prostate (TURP), which is where part of your prostate is cut away.

You will need to arrange for someone to drive you home after your procedure. You won’t be able to drive yourself because of the effects of the anaesthetic. It may also be a good idea to arrange for a friend or relative to stay with you for the first 24 hours after your treatment.

On the day

When you arrive at the hospital on the day of your treatment, you may be asked to have an enema. This is fluid or a suppository that is put into your rectum (back passage) to empty your bowels.

You usually have HIFU as a day-case, under a general anaesthetic, which means you’ll be asleep during the treatment. You may have a spinal or epidural anaesthetic instead of a general anaesthetic. This completely blocks pain from your waist down, but means you will be awake during the procedure. If you have a spinal or epidural, you may also have a sedative to help you relax.

If you're having a general anaesthetic, your doctor will ask you not to eat or drink beforehand, usually for about six hours. Make sure that you follow any instructions that you’re given.

Your surgeon will ask you to sign a form, to give your consent for the procedure to go ahead.

What happens during HIFU for prostate cancer?

HIFU can take up to three hours. However, the exact time depends on the size of your prostate and how much of it is being treated.

Once you are under anaesthetic, your surgeon will put a thin, hollow tube called a catheter into your bladder. Then, your surgeon will place the HIFU probe in your back passage. The probe gives out a beam of ultrasound waves that kills the cancer cells in your prostate by heating them up.

Your doctor will use ultrasound scanning during the procedure to make sure that the probe is in the right position, and directed at the right area of your prostate. The probe only treats a very small area at a time so the surgeon will move it until all the prostate tissue containing the cancer has been destroyed.

What to expect after HIFU for prostate cancer

After the procedure, you’ll need to rest until you have recovered from the effects of the anaesthetic. If you’ve 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.

HIFU can cause your prostate to swell. This can sometimes block the flow of urine, so you will have a tube into your bladder (a urinary catheter) after your treatment. The catheter will go either from your penis into your bladder or through a small incision in your abdomen. You may need the catheter for one or two weeks, but your doctor will tell you exactly how long.

You can usually go home the same day that you have the procedure. A nurse will show you how to manage your catheter at home, and tell you when to return to hospital to have it removed. You will have a course of antibiotics to stop you getting an infection.

A general anaesthetic temporarily affects your co-ordination and reasoning skills. So you won’t be able to drive for at least 24 hours and will need someone to drive you home.

You shouldn’t drive until you have fully recovered from your operation, or if you are taking painkillers that could make you drowsy. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and check with your surgeon.

Recovering from HIFU for prostate cancer

Pain relief

HIFU may cause some discomfort or pain around your back passage for around three or four days. 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.

Check-ups

You’ll need to have regular check-ups to make sure you’re recovering well. During these checks, your oncologist will look for any side-effects you may be developing. They’ll also monitor the level of a protein called prostate specific antigen (PSA) in your blood. Your PSA level should fall over the months following your procedure. Your doctor will be checking to make sure your PSA doesn’t start to rise again, as this could be a sign of the cancer coming back.

You will also have regular MRI scans or other scans and biopsies to make sure the cancer hasn’t come back.

If there are still cancer cells in your prostate after your procedure, or the cancer returns, your doctor is likely to suggest other treatments. Your doctor will explain what your other treatment options are.

Side-effects of HIFU for prostate cancer

HIFU aims is to be less invasive (ie, it doesn’t involve needles or the need to cut your skin) and less toxic than some other treatments for cancer. Because of this, side-effects may be less likely. However, HIFU is only given as part of clinical trials (or where results and outcomes are always recorded). This is so doctors can continue to monitor how well HIFU works and if there are any long-term side-effects.

Side-effects of HIFU for prostate cancer include the following.

  • Mild pain or discomfort in your back passage – this usually goes away within a few days.
  • Blood and prostate tissue in your urine – this can last for up to a couple of months.
  • Passing urine more often or needing to go urgently – this can last for two or three months after HIFU.
  • Bladder infections. These can cause a burning sensation when you pass urine and you may have a temperature. Contact your GP if you have any of these symptoms – you may need antibiotics.
  • Difficulty passing urine, or needing to go more often after your catheter is removed. This is usually temporary, but do tell your doctor.

HIFU may affect your ability to get an erection, especially in the first few weeks after the treatment. Your orgasms may also feel different.

Talk to your cancer specialist if you’re worried about the effect of the procedure on your sex life or fertility.

Complications of HIFU for prostate cancer

Complications are problems that can happen during or after the procedure. The possible complications of HIFU for prostate cancer include the following.

  • You may be more likely to leak urine when you cough, sneeze, or move suddenly, however this is rare.
  • Narrowing of the neck of the bladder can cause difficulty passing urine. Some men need minor surgery to correct this.
  • Difficulty getting an erection after HIFU treatment often improves over time, but some men may be permanently unable to get an erection (impotent). Do speak to your doctor as there is treatment available.
  • Sometimes, after treatment to the prostate, semen goes back towards the bladder rather than out of the penis. This is called dry or ‘retrograde’ ejaculation and may mean that you can no longer father children naturally. You may be able to store some sperm before you have HIFU if you’re planning on children (or more children) in the future.

Only a small number of men will be affected by these complications. And these complications can also occur with other treatments for prostate cancer. However, since HIFU for prostate cancer is still part of ongoing clinical studies, we don’t yet know how common these problems may be, or if the procedure can cause other long-term problems.

If your prostate cancer is only in one part of your prostate, you may be able to have treatment aimed at a small area (focal HIFU) rather than having the whole prostate gland treated (whole gland HIFU). Having focal HIFU may further lower your risk of having complications such as erection problems or incontinence.

Frequently asked questions

  • After HIFU treatment, you will have a catheter for around one week. It will either go into your bladder through your penis, or directly through a small incision in your lower abdomen (a supra-pubic catheter).

    You may feel some discomfort when the catheter is removed but it shouldn't be painful and is usually over very quickly. Your nurse may ask you to breathe in, and then breathe out slowly as the catheter is removed.

    If you have a supra-public catheter, you will probably have a small stitch (suture) holding it in place. A small balloon at the tip of the catheter is inflated to prevent it falling out. It shouldn’t be uncomfortable to have this taken out, although you might feel a slight twinge.

    Some men can find it difficult or painful to pass urine at first, after having the catheter removed. This shouldn’t last for long. Speak to your doctor or nurse if you continue to have problems.


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Related information

    • High-intensity focused ultrasound therapy. NCI Dictionary of Cancer Terms. National Cancer Institute. www.cancer.gov, accessed March 2018
    • High intensity focused ultrasound (HIFU). Cancer Research UK. www.cancerresearchuk.org, last updated August 2015
    • Prostate cancer: diagnosis and management. National Institute for Health and Clinical Excellence (NICE), January 2014. www.nice.org.uk
    • A trial of high intensity focused ultrasound (HIFU) to delay further treatment for prostate cancer. Cancer Research UK. www.cancerresearchuk.org, last updated April 2016
    • Focal therapy using high-intensity focused ultrasound for localised prostate cancer. National Institue for Health and Clinical Excellence (NICE), April 2012. www.nice.org.uk
    • Personal correspondence. Professor Raj Persad. Consultant Urologist, Spire Bristol Hospital, June 2018
    • High-intensity focused ultrasound (HIFU). Prostate Cancer UK. www.prostatecanceruk.org, last updated September 2015
    • Hatiboglu G, Popeneciu IV, Deppert M, et al. Quality of life and functional outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer. BM Central Urol 2017; 15:5. doi: 10.1186/s12894-017-0198-2
    • Anaesthesia explained. Royal College of Anaesthetists. www.rcoa.ac.uk, published November 2015
    • A trial looking at high intensity focused ultrasound to treat only areas of the prostate gland that contain cancer. Cancer Research UK. www.cancerresearchuk.org, last updated October 2017
    • Assessing fitness to drive – a guide for medical professionals. GOV.UK. www.gov.uk, published October 2017
    • Cordeiro ER, Cathelineau X, Thuroff S, et al. High‐intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer. BJU Int 2012; 110(9):1228–42. doi: 10.1111/j.1464-410X.2012.11262.x
    • Urinary catheters 6: removing an indwelling urinary catheter. Nurs Times. nursingtimes.net, published May 2017
    • Suprapubic urinary catheter. Great Ormond Street Hospital for Children. gosh.nhs.uk, last reviewed December 2014
    • Suprapubic catheter. Bladder and Bowel Community. www.bladderandbowel.org, assessed 21 June 2018
  • Reviewed by Alice Rossiter, Specialist Editor, Bupa Health Content Team, July 2018
    Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
    Next review due July 2021



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