High Intensity Focused Ultrasound (HIFU) for Prostate Cancer
High Intensity Focused Ultrasound (HIFU) is a minimally-invasive ablation which can be used for cases of localized (contained) prostate cancer. Ultrasound waves are focused with extreme precision instantly and effectively destroying the targeted cells within the prostate. The ultrasound waves are delivered via a probe which is inserted into the rectum. The duration of the HIFU procedure is one to three hours and can be performed under general or spinal anesthesia.
The procedure requires only a short hospital stay (usually outpatient procedure) and has a low complication rate. The prostate tissue will be destroyed by the thermal effect of HIFU (temperature rising to 85°C), therefore there is no radiation involved.
Who should undergo HIFU?
Your urologist may recommend HIFU if you require treatment for localized prostate cancer for the first time and wait a minimally invasive treatment.
Are there reasons why, or circumstances in which HIFU procedure is not a possible option?
Almost none – this type of procedure is not the most appropriate for men with very large prostates but if the prostate is slightly enlarged, a TURP (Transurethral Resection of the Prostate) can be performed to reduce the size of the gland so that the HIFU procedure is made possible. In some cases, HIFU is not recommended for men who have experienced hardening of the rectal wall due to previous cancer treatments.
Is HIFU FDA approved?
The first treatment was performed in 1993 and the latest generation of Ablatherm HIFU device was given market approval for Europe (CE) in 2005 and for the USA (FDA) in 2015. As of 2015, over 45,000 patients have benefited from Ablatherm HIFU in 250 centers across the world.
How does HIFU work?
The urologist uses the HIFU device to ablate prostate tissue. The doctor inserts a probe into the rectum. This probe includes an imaging component which allows to visualize the treatment area on a computer screen. The probe also includes a transducer which emits the focused ultrasound waves.
The urologist inputs a treatment plan into the computer which then controls and aims the ultrasound waves. These are focused with extreme precision onto the targeted cancerous cells in the prostate, causing a very brief rise in temperature (around 85° C). The targeted tissue is then instantly and effectively destroyed, while the surrounding tissue is preserved.
The HIFU machine has numerous safety checks which are constantly monitored throughout the procedure to ensure patient safety. This means that the treatment is always delivered to the same high standard and quality
What does the procedure involve?
The patient will be asked to come into hospital the night before the treatment. Every patient will be given a digestive preparation (enema) to prepare the rectum. The procedure is generally performed under local (epidural) or general anesthesia to ensure that the patient remains completely still. He will lie on his righthand side and the Urologist will place a gel-coated probe into the rectum. Subsequently, the prostate will be located and the whole prostate or the affected area will be treated. The HIFU procedure can then start - 400 to 600 shots of High Intensity Focused Ultrasound waves are generally applied. The procedure can last between one and three hours.
Why is catheterization needed?
The prostate swells after treatment and presses on the urethra (canal which discharges urine from the bladder) so catheterization to remove urine is necessary until the swelling subsides. To reduce the need for catheterization after treatment, a transurethral resection of the prostate (TURP) can be performed before the procedure on a separate day. TURP involves removing the part of the prostate which presses on the urethra by passing a thin tube up the urethra via the penis.
Is the HIFU procedure painful?
The procedure itself is not painful as it is carried out under spinal anesthetic (epidural) or general anesthetic. Pain at the end of the treatment is rare, although most patients feel a slight rectal discomfort which disappears after a few days. The procedure is minimally invasive so there are no wounds and patients do not experience the burning sensation often associated with radiotherapy.
What happens after treatment?
Most patients can go back to eating normal food the evening after treatment and are discharged from the hospital the same day. The urinary catheter is generally removed three or four days later. Medication may be prescribed after HIFU to prevent any infection of the urethra or bladder. In the period after treatment the patient may experience some discomfort including mild bleeding at the start of urination, frequent and sometimes urgent urination, urine leakage during physical exertion or coughing, and sometimes the elimination of dead cancer cells in the urine. Infections with fever are rare but possible and require antibiotics. These side effects disappear in the weeks following the treatment.
What long-term follow up is required?
Usually PSA levels are checked every three months and a biopsy may be undertaken six months after treatment.
The ablation of prostate tissue with High Intensity Focused Ultrasound is an option with many advantages:
- Non-invasive procedure
- Destruction of the cancerous tissue with minimal effect to the surrounding organs
- Does not use radiation
- Can be performed under spinal anesthesia
- Can be performed in one session
- Requires only a short stay in hospital
- Other therapeutic alternatives can be considered if results are unsatisfactory