What is HIFU?

HIFU uses high frequency ultrasound waves to heat and destroy cancer cells in the prostate.

HIFU is one of the treatments that's used for prostate cancer that is completely contained within the prostate (localised prostate cancer).

HIFU is also used to treat cancer that has come back after radiotherapy (recurrent prostate cancer). This is called salvage HIFU.

HIFU is newer than some of the other treatments for prostate cancer. We don't know as much about how well it works and about the risk of side effects in the long term. Because of this, it's only available in specialist centres in the UK or as part of a clinical trial.

What other treatments are available?

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How does HIFU treat prostate cancer?

HIFU heats and destroys cancer cells in the prostate. Pulses of ultrasound waves travel through the wall of the back passage (rectum) into the prostate gland. This ultrasound energy causes the prostate cells to heat up.

Because the heat destroys both cancer cells and normal prostate cells, the treatment is focused on the prostate gland to avoid damaging other areas.

Some specialists are looking at a newer way of using HIFU called focal HIFU. This means that HIFU is used to treat the areas of the prostate that contain the cancer, rather than treating the whole prostate gland. Early research suggests it might reduce the risk of side effects compared to treating the whole prostate gland, because less of the healthy tissue is damaged.This is a new area of research and more needs to be known before it’s made widely available. 

What are the advantages and disavantages?

An advantage for one person might not be for someone else. Talk to your doctor or nurse about your own situation.

Advantages

  • HIFU has fewer risks than surgery, so it might be suitable for men with other health problems.
  • You only need a short hospital stay - less than 24 hours.
  • HIFU may be an option if the cancer comes back after treatment with external beam radiotherapy (EBRT). This isn't the case with all treatments.

Disadvantages

  • In the UK, HIFU is only available in specialist centres or as part of a clinical trial.
  • Compared with other treatments, we don't know as much about how well HIFU works in the long term.
  • As with other treatments, there is a risk of side effects including urinary problems and erectile dysfunction.

What does treatment involve?

Before the treatment

If you have a large prostate gland, you might have hormone therapy to shrink it before starting HIFU. Your surgeon might also suggest an operation called a transurethral resection of the prostate (TURP) before you have HIFU, to make the prostate smaller. As with all treatments, this has some side effects.

On the morning of your treatment with HIFU you’ll be given an enema, to help you empty your bowels. This is a liquid medicine which is given directly into your back passage (rectum). You’ll be asked not to eat or drink for around six hours before the HIFU treatment.

Treatment

You might have a general anaesthetic so that you are asleep during the treatment. Or you might have a spinal or epidural anaesthetic (injection into your spine) so that you’re awake but can’t feel anything in your lower body. With this, you may also be given some medicine (a sedative) to make you feel sleepy.

You will have a catheter inserted at the start of the procedure. A catheter is a thin tube that is passed into your bladder, either through the penis (urethral catheter) or through the wall of your abdomen (supra-pubic catheter), to drain urine out of the body.

Then, to give the treatment, your surgeon will insert a probe into your back passage (rectum). This probe gives out high intensity ultrasound waves, which are focused on an area of the prostate gland. The probe is surrounded by a cooling balloon, to protect your back passage from the high temperatures. It takes up to three hours to treat the whole prostate gland.

Going home after treatment

Usually, men go home on the same day as the treatment. Your doctor or nurse will check that you’ve recovered from the anaesthetic and are fit to go home. You may have pain in the area between your testicles and back passage but you’ll be given pain-relieving drugs to take at home. You might also get antibiotics to prevent any possible infection and a medicine called a laxative to help you empty your bowels.

Before you go home your doctor or nurse will show you how to look after your catheter. They’ll also give you an appointment to return to hospital to have your catheter removed. You will need a catheter to help you urinate for up to two weeks after treatment. You might need a catheter for longer if you have HIFU after radiotherapy.

What happens afterwards?

After your HIFU treatment you will have regular appointments with your doctor or nurse to check your PSA level and monitor any side effects.

Your PSA is likely to reach its lowest level a few months after treatment.If your PSA doesn’t fall or if it starts to rise again, you might need to have a biopsy to see if there are cancer cells in the prostate gland. You might also have scans to find out if the cancer has spread to other parts of the body. These could be CT, MRI or bone scans, for example. If the biopsy or scans show up prostate cancer, your doctor or nurse will talk to you about further treatment options.

 

 

What are the side effects?

Like all treatments, HIFU can cause side effects. These affect each man differently, and you might not get them all.

The most common side effects are urinary problems and difficulty getting and keeping an erection (erectile dysfunction).

You’re more likely to get side effects if you have repeat HIFU treatment or if you have already had other treatments for prostate cancer. This is because these treatments might have already caused some damage to the area around the prostate.

Ask your doctor or nurse for more information about side effects. They should be able to show you the results of the treatments they have carried out and put you in touch with other men who've had the treatment.

Short-term side effects

These can develop soon after your treatment.

You might notice blood in your urine while the catheter is in place. You might also notice some small pieces of prostate tissue in your urine for up to two months after your HIFU treatment. This is normal, but you should contact your doctor or nurse straight away if you are worried or if you develop any new symptoms such as pain or a high temperature.

HIFU can make your prostate gland swell temporarily. This might make it hard to pass urine for a short while after your catheter has been removed. If you notice your flow of urine has slowed down or you are unable to urinate, you should get treatment straight away. Contact your doctor or nurse or go to your hospital accident and emergency (A&E) department.

They might suggest a temporary catheter until the swelling has settled. This is a tube that you can use to drain urine from your bladder whenever you need to go to the toilet.

Some men get a urine infection after treatment. If you have a urine infection, you might need to urinate more often and with less warning and you might get a burning feeling when you urinate. Other signs of a urine infection include a high temperature, burning sensation or dark, cloudy or unpleasant smelling urine. Your doctor can prescribe antibiotics to treat a urine infection.

Longer-term side effects

Most short-term side effects will settle down after your HIFU treatment, but you can have later and long-term side effects.

Urinary problems

HIFU can cause urinary problems. These include leaking urine, and problems passing urine. You may have symptoms straight after treatment, or they might develop some time later. Research suggests that if you have a large prostate, having a TURP operation before HIFU treatment might reduce the risk of having problems urinating. This is because the TURP operation removes any parts of the prostate that are pressing on the tube which you pass urine through, making it easier to urinate.

Some men find it hard to urinate after the catheter is removed. This can sometimes be a longer-term problem caused by the urethra or the opening from the bladder getting narrower. If this becomes a problem, you might be offered a minor procedure to stretch the narrowed area.

Some men find they leak urine (urinary incontinence) after HIFU. This is more likely if you have HIFU after external beam radiotherapy. You might find that you leak a little bit when you cough, sneeze or exercise. Or you may need to go more often or more urgently.

Talk to your doctor, or nurse or GP if you have any of the side effects described above. There are a number of things that can help you manage urinary problems, including lifestyle changes, pelvic floor muscle exercises and treatments. Your doctor or nurse may be able to suggest some practical things you can do to make things easier. They may also refer you to an NHS continence service, run by nurses and physiotherapists who specialise in urinary problems.

Sexual problems

Some men have problems getting an erection (erectile dysfunction) after HIFU treatment. HIFU can damage the blood vessels and nerves that control erections. There are treatments available to help manage erection problems.

Also after HIFU, some men ejaculate less semen, or no semen at all. But they can still orgasm (climax). This could mean that you can’t have children after treatment. If you are planning to have children, you might be able to store your sperm before the operation for use in fertility treatment. If this is important to you, ask your doctor or nurse if this option is available locally.

If you’ve had a TURP operation before HIFU, you may find that when you orgasm, the semen travels backwards into the bladder rather than out through the penis. It’s then passed out of the body the next time you urinate. This is called retrograde ejaculation. It’s not harmful and shouldn’t affect your enjoyment of sex, but it might feel quite different from the orgasms you are used to.

Talk to your doctor or nurse if you have any sexual problems. They can discuss with you possible treatment options for erection difficulties and they can prescribe treatment free on the NHS. You can also ask your doctor, nurse or GP to refer you to your local erectile dysfunction (ED) clinic.

Bowel problems

Some men get a burning sensation or some bleeding from the back passage after HIFU treatment.

Very rarely, HIFU causes a hole (fistula) between the urethra and the back passage. This affects less than 1 in 100 men (1 per cent). It is more common, but still rare, for men who have already had radiotherapy. Recent studies suggest that about 3 out of 100 men (3 per cent) who have HIFU after external beam radiotherapy develop a fistula.

Sometimes pain and infections of the urethra can be early signs of a fistula, although these can also be caused by something else. Contact your doctor or nurse if your urine is strong smelling or you have a temperature, which could be signs of an infection. Discharge from the urethra or discharge or diarrhoea from the back passage may also be signs of a fistula. If you develop a fistula, you will need to have an operation to repair the hole.

Questions to ask your doctor or nurse

  • Will I need a TURP before my HIFU treatment?
  • Will I need hormone therapy before my HIFU treatment?
  • What are the chances of short term or long term side effects with this treatment?
  • How can I manage any side effects I get?
  • How will I know if the treatment has worked?
  • What should my PSA level be after treatment and when will you check it again?
  • If my PSA doesn't fall, or if it continues to rise, what other treatments are available?