High intensity focused ultrasound (or HIFU) uses high-frequency energy beams targeted at the prostate gland to heat and destroy prostate cancer cells.
HIFU for prostate cancer is a newer treatment and much is still being learned about the longer term benefits and potential side effects. It also requires special skills and equipment. As a result, depending on where you live, HIFU to treat prostate cancer may not be in common use, and only available in specialist centers or through clinical trials.
How is HIFU treatment done?
You’ll be put under a general anesthetic (you’ll be asleep and not feel anything), and a urologist will insert a small ultrasound probe into your rectum. The urologist uses this probe to clearly see the prostate, and then directs the heating energy to the part of the prostate that contains cancer.
In treating prostate cancer, HIFU can be applied to the whole prostate gland (whole prostate HIFU) or to specific parts of the prostate (focal HIFU). Both types of HIFU are day procedures and you should be able to head home the same day as your treatment. You’ll need a catheter to help your bladder drain urine for a few days after (a little longer if you’ve had whole prostate HIFU).
Whole prostate HIFU
Whole prostate HIFU treats the entire prostate gland and takes about 3 hours. It is used when cancer is more widespread through the prostate.
Focal HIFU treats select parts of the prostate and takes around 1 to 2 hours. It is used when only specific areas of the prostate require treatment. Parts of the prostate that don’t have cancer, or where cancer is slow growing, are not treated.
Does HIFU treatment for prostate cancer have side effects?
As with any treatment for prostate cancer, HIFU can result in unwanted effects.
The heat from the ultrasound causes the prostate to swell—this is normal. It shouldn’t be painful, but it can be difficult to urinate (pee). To make sure your bladder gets drained, a thin tube (or catheter) will be inserted before you have HIFU and remain there until the swelling has gone.
Blood in your urine (pee).
Blood from your stool (or poop).
Blood in your semen.
Swelling in the testicles.
Soon after HIFU treatment you may experience:
If you have a fever or swelling in the testicles see your doctor urgently—you may have an infection that needs to be treated.
The risk of side effects is higher, and symptoms can be more pronounced for whole prostate HIFU compared to focal HIFU which usually damages less of the healthy tissue. Problems are also more likely to happen if you’ve had HIFU treatment more than once, or if you’re having other treatments at the same time.
What are the odds of side effects from focal HIFU?
Around 1 in 100 men who have focal HIFU will have some minor urine leakage, which is comparable to the standard treatments of surgery and radiation therapy.
2 in 3 men who have good erections before prostate cancer treatment will still have good erections after treatment. 1 in 3 men will need to have tablets or other treatments to help the erections. Many men notice the volume of ejaculate is reduced, but this is not a problem for most men.
1 in 4 men who have a focal HIFU treatment will need another by 5 years. 1 in 15 men will need surgery or radiation therapy after a focal HIFU treatment. Surgery is usually more difficult after focal HIFU.
What about whole prostate HIFU?
With whole prostate HIFU, there are a lot of the same side effects, but they may be to a greater degree. It’s best to speak with your doctor to understand more about whole prostate HIFU.
Recovering after HIFU for prostate cancer
You’ll be able to go home the same day as treatment once you’ve recovered from the anesthesia. The catheter draining your urine will need to stay for a few days following treatment. Your care team will show you how to take care of the catheter and arrange a time to have it removed. You’ll also have regular follow-ups with your doctor to check how you’re handling side effects, monitor how your cancer is responding to treatment, and ask any questions that are on your mind.
Your doctor will keep tracking your PSA levels every 3 to 6 months for a few years, to make sure the HIFU has worked. You might also have an MRI or biopsy to check if the cancer is gone.
Questions to ask your doctor or care team
It’s important to talk to your doctor or care team to make sure you have the information you need before, during, and after treatment.
What are the side effects of HIFU?
What are the advantages of this treatment versus my other options? What are the disadvantages?
What are my other treatment options?
What happens if HIFU doesn't work? What treatment can I have then?
How long until I know if the treatment has worked?
Here are some questions you might want to ask:
Is HIFU right for me?
If you have early-stage prostate cancer (that hasn’t spread outside the prostate), or prostate cancer that’s come back after radiation therapy, HIFU may be an option for you. The size of your prostate gland can also be a factor in getting good results from HIFU—ideally small to medium sized prostates show better HIFU results. But remember, this treatment isn’t available everywhere. Speak to your primary care doctor or urologist to understand more and whether you can access it.