HIFU is still being tested as a treatment for prostate cancer. There isn't enough proof about how well it works to recommend that everyone with prostate cancer should have it. But you might be able to have it as part of a clinical trial, if your cancer hasn’t spread outside your prostate.
HIFU for prostate cancer has both pros and cons. It’s important to discuss these with your surgeon or oncologist (a doctor specialising in treating cancer). You may also want to ask about the side-effects of the procedure, and whether or not there are any alternative treatment options. This will help you to decide if HIFU is right for you.
Studies so far have shown that HIFU has potential as an effective treatment for prostate cancer. It’s important to understand that these have been early studies that haven’t looked at how well the treatment works over the long term. More research is needed to explore this.
HIFU uses sound waves, which have fewer side-effects and risks than other cancer treatments, such as radiotherapy or surgery.
As HIFU is less invasive than other cancer treatments. This means you need only a short stay in hospital. You should be able to go home on the same day of your procedure.
HIFU is a relatively new treatment and is still being tested. This means there isn’t much information about how well it works in the long term, or what long-term side-effects it may cause.
Although side-effects may be less likely with HIFU, there’s still a chance that you may have some. For example, you may have erection problems after the procedure (although, these tend to be temporary). Some men have problems with urination and are more likely to have bladder infections, after the procedure. See our section on complications for more information.
After the procedure, you may not be able to release semen during your orgasms. This is known as dry ejaculation. It could prevent you from having children, which may be important to you.
There aren’t many places where you can have HIFU, because the procedure is generally only carried out in clinical trials.
Before the procedure
Before you have your HIFU procedure, your doctor will ask you to have an MRI scan and a biopsy. This is to find out exactly where in your prostate the cancer is. This will help to make sure that only the area with the cancer is treated with HIFU. A biopsy involves taking tiny samples of tissue from your prostate, using a special syringe inserted into your rectum (back passage).
If you have an enlarged prostate, you may need another treatment before having HIFU. This is to make your prostate smaller. For example, you may have hormone therapy, which helps shrink your prostate gland. Or you may have transurethral resection of the prostate (TURP), in which part of your prostate is cut away.
You may want 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 procedure.
On the day
You’ll be admitted to hospital on the day of your procedure. You may be asked to have an enema before 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 under general anaesthesia, which means you’ll be asleep during the procedure. You may be given a spinal or epidural instead of a general anaesthetic. This completely blocks pain from your waist down, but means you will stay awake during the procedure. If you have a spinal or epidural, you may also be given a sedative, to help you relax.
If you're having a general anaesthetic, you’ll be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. Make sure that you follow any instructions that you’re given.
Your surgeon or oncologist will ask you to sign a form, to give your consent for the procedure to go ahead.
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 have been anaesthetised, your surgeon or oncologist will insert a thin, hollow tube called a catheter into your bladder. They will either pass the catheter up through your penis or insert it through the wall of your abdomen. Then, your surgeon will pass a lubricated probe into your back passage. The probe gives out a beam of ultrasound waves that kills the cancer cells in your prostate by heating them up.
You will have MRI scans taken during the procedure. This will help to make sure that the probe is always in the right position, and directed at the right area of your prostate.
After the procedure, you’ll probably 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’ll have a very thin tube called a catheter attached to you, that drains urine from your bladder into a bag. The catheter will pass out through either your penis or a small cut in your abdomen (tummy). You may need to keep it in for up to two weeks, but your doctor will tell you exactly how long.
You’ll usually be able to go home on the day of the procedure, if you feel ready. A nurse will tell you how to manage your catheter at home, and when to return to hospital to have it removed. You may be prescribed a course of antibiotics to stop you getting an infection.
General anaesthesia temporarily affects your co-ordination and reasoning skills. So if you have this, you won’t be able to drive for at least 24 hours afterwards. You’ll need someone to drive you home.
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.
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.
You’ll need to have regular check-ups to ensure that you are recovering well. During these checks, your oncologist will look for any side-effects you may be developing. They’ll also monitor your blood level of a protein called prostate specific antigen (PSA). Your blood PSA level should fall after your procedure. If it doesn’t, it may be because there are still cancer cells in your prostate.
You’ll be asked to have regular MRI or other scans and biopsies to see if the cancer returns.
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 treatment options are.
HIFU may affect your ability to get an erection, especially in the first few weeks after the treatment.
Your orgasms may also feel different, because you may not be able to release semen. Talk to your oncologist or GP if you’re worried about the effect of the procedure on your sex life or your fertility.
As with any procedure, HIFU can cause some unwanted side-effects. These are usually mild and temporary.
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.
- Difficulty passing urine, or needing to pass urine more often: this should only be a temporary problem.
Complications are unexpected problems that can happen during or after the procedure. The possible complications of HIFU for prostate cancer include the following.
- Bladder infections: these can cause fever and a burning sensation when you pass urine. You should contact your GP if you have these symptoms, as you may need antibiotics.
- Leaking urine (incontinence): you may be more likely to leak urine when you cough, sneeze or move suddenly.
- Difficulty passing urine: this may happen if your urethra (the tube that carries urine out of your penis) narrows.
- Erection problems: you may not be able to get an erection during the first few months after HIFU treatment.
- Fertility problems: you may not be able to release semen after having HIFU, which means you won’t be able to have children naturally.
Only a small number of men will be affected by these complications. However, since HIFU for prostate cancer is still being studied, we don’t know how common these problems may be, or if the procedure can cause other long-term problems.
A newer technique called focal HIFU can be used to focus the sound waves on the cancer cells in your prostate, limiting damage to healthy cells. This may lower your risk of having complications such as erection problems or incontinence.
It's possible that you may have some loss of bladder control after HIFU treatment for prostate cancer.
Your bladder and urethra (the tube that carries urine out of your penis) lie just above your prostate gland. There is a small chance that HIFU treatment can damage them, causing problems with controlling your bladder. For example, you may leak urine when you cough, sneeze or move. Or you may feel the need to pass urine more frequently and urgently. This tends to occur in the first three months after the procedure, and usually goes away.
Speak with your doctor if you are having urinary problems. He or she will be able to give you advice on how to deal with them.
FAQ: Catheter removal Is it painful to have the catheter removed after HIFU treatment for prostate cancer?
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 out of your penis). This can make it difficult to pass urine. Because of this, your surgeon will need to fit a thin tube called a catheter at the time of your surgery. The catheter will drain urine from your bladder into a bag.
The catheter can be passed up through your penis into your bladder and left in place for around two weeks. Or it can be placed 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. Some men can find it difficult or painful to pass urine at first, after having the catheter removed, but this should soon pass. Speak to your doctor or nurse if your problems continue.
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- High-intensity focused ultrasound for prostate cancer. National Institute for Health and Care Excellence (NICE), 2005. www.nice.org.uk
- Focal therapy using high intensity focused ultrasound for localised prostate cancer. National Institute of Health and Care Excellence (NICE), 2012. www.nice.org.uk
- Prostate cancer: diagnosis and treatment. National Collaborating Centre for Cancer, January 2014. www.nice.org.uk
- High intensity focused ultrasound (HIFU). Prostate Cancer UK. www.prostatecanceruk.org, accessed 18 September 2015
- A trial looking at using high intensity focused ultrasound (HIFU) to delay further treatment for prostate cancer. Trial design. Cancer Research UK. www.cancerresearchuk.org, 26 November 2013
- Biopsy of the kidney, bladder, and prostate. The Merck Manuals. www.merckmanuals.com, August 2014
- Your spinal anaesthetic. Royal College of Anaesthetists (RCOA), 2014. www.rcoa.ac.uk
- Treatment options for prostate cancer. Cancer Research UK. www.cancerresearchuk.org, reviewed 21 February 2014
- Monitoring prostate cancer. Cancer Research UK. www.cancerresearchuk.org, reviewed 21 February 2014
- Types of surgery for prostate cancer. Cancer Research UK. www.cancerresearchuk.org, reviewed 21 February 2014
- About radiotherapy for prostate cancer. Cancer Research UK. www.cancerresearchuk.org, reviewed 24 February 2014
- Cryotherapy for prostate cancer. Cancer Research UK. www.cancerresearchuk.org, reviewed 25 February 2014
- Common concerns and FAQs. The Royal College of Anaesthetists. www.rcoa.ac.uk, accessed 18 September 2015
- Prostate cancer tests. Cancer Research UK. www.cancerresearchuk.org, reviewed 20 February 2014
- Urinary problems. Prostate Cancer UK. www.prostatecanceruk.org, reviewed June 2014
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