High intensity focused ultrasound (HIFU)
High intensity focused ultrasound (HIFU) uses high frequency ultrasound waves to heat and destroy cancer cells in the prostate.
Each hospital and specialist team will do things slightly differently. Use this page as a general guide to what to expect and ask your specialist team for more details about treatment and help available to you.
Updated July 2011
To be reviewed July 2013
Who can have HIFU?
HIFU is one of a range of treatments for cancer that has not spread outside the prostate gland (localised prostate cancer).
Alternative treatments include:
- Radical prostatectomy (surgery)
- External beam radiotherapy
- Active surveillance
- Watchful waiting
- Cryotherapy (available as part of a clinical trial)
HIFU is a relatively new treatment and we do not know very much about how effective it is at treating prostate cancer in the long term or how it may affect your everyday life. Because of this, HIFU is not widely available as a first treatment and may be available as part of a clinical trial.1 It is occasionally used to treat cancer that has come back after radiotherapy (recurrent prostate cancer). For more information about other treatment options after your first treatment read our booklet, Recurrent prostate cancer: If your cancer comes back - risk and treatment.
HIFU may be a suitable treatment option if your cancer is contained within the prostate gland (localised prostate cancer). It can be used if you have a Gleason score of 7 or lower, a prostate specific antigen (PSA) level of less than 15ng/ml and a small prostate gland (less than 40mls).2 It may be more suitable for men with other health problems because it is less invasive than surgery (radical prostatectomy) to remove the prostate. Our page on diagnosis gives more information about Gleason scores and PSA levels.
If HIFU is a suitable treatment option for you and you have a large prostate gland, you may be given hormone therapy to shrink the gland before starting treatment. Your surgeon may also suggest a transurethral resection of the prostate (TURP) operation to remove excess tissue from the prostate. You can find out more about this operation in our fact sheet Transurethral resection of the prostate (TURP).
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 and are focused onto a small area. This ultrasound energy causes the prostate cells to heat up. This heat destroys cancer cells and normal prostate cells. The treatment is focused on the prostate gland to avoid damaging nearby orans and the areas around the prostate.
Some specialists are looking at a new way of using HIFU called focal therapy. This means that HIFU is used to treat specific areas of cancer within the prostate, rather than treating the whole prostate gland. Early research suggests it may reduce the risk of side effects compared to treating the whole prostate gland 3. This is a new area of research and we need more information about how successful this treatment option is before it is made widely available. You can ask your specialist about having focal therapy as part of a clinical trial.
What are the advantages and disadvantages?
- HIFU treatment is not as invasive as radical prostatectomy, brachytherapy or cryotherapy.
- It requires a short hospital stay of less than 24 hours.
- The treatment can be repeated if necessary.
- HIFU is currently only available in a few centres around the UK as part of clinical trial.
- HIFU may be as effective at controlling prostate cancer as some other treatments. However, because it is a relatively new treatment and the technology is still developing, we do not know how effective it is in the long term (beyond five years).
- There is a risk of side effects including urinary problems and erectile dysfunction. The risk is higher if you are having repeat treatments with HIFU or if you have already had other prostate cancer treatments.
- You will need a catheter to help you pass urine for up to two weeks after treatment. This is a thin tube that is passed into your bladder, either through the penis or through the wall of your abdomen. You may need a catheter for longer if you are having HIFU as a second treatment after radiotherapy.
What does treatment involve?
Before the treatment
On the morning of your treatment you will be given an enema, to help you empty your bowels. An enema is a liquid medicine which is given directly into your back passage (rectum). You will be asked not to eat or drink for around six hours before the HIFU treatment.
If you are having a TURP operation to remove excess prostate tissue, your surgeon will do this immediately before your HIFU treatment.
You may be given a general anaesthetic so that you are asleep during the treatment. Or you may have a spinal or epidural anaesthetic (injection into your spine) so that you are awake but cannot feel anything in your lower body. If you have a spinal or epidural anaesthetic, you may also be given some medicine to make you feel sleepy (a sedative).
Your surgeon will insert a probe into your back passage (rectum). This probe gives out a series of high intensity ultrasound beams, 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 between two to three hours to treat the whole prostate gland.
Going home after treatment
You will usually be able to go home on the same day as your treatment. Your specialist team will check that you have recovered from the anaesthetic and are fit to go home. You will be given pain relieving drugs to take at home and you may also be given antibiotics to prevent any possible infection.
Before you go home your specialist team will show you how to look after your catheter. They will also give you an appointment to return to the hospital to have your catheter removed.
You may notice blood in your urine while your catheter is in place. You may also notice some small pieces of tissue in your urine for up to two months after your HIFU treatment. This is normal, but you should contact your specialist team straight away if you are worried or develop any new symptoms such as pain or a high temperature.
HIFU treatment may cause your prostate gland to swell temporarily and it may make it difficult for you to pass urine after your catheter has been removed. Research suggests that about one out of 20 men (five per cent) may have problems emptying their bladder after HIFU4. If you notice your flow of urine has slowed down or you are unable to pass urine, contact your specialist team or GP. They may suggest you use an intermittent catheter until the swelling has settled. This is a hollow tube that you can use to drain urine from your bladder throughout the day whenever you need to go to the toilet.
Some research suggests that about two out of 25 men (eight per cent) may get a urine infection after treatment.4 If you have a urine infection, you may find that you need to pass urine more often and with less warning than before treatment. You may also get a burning feeling when you pass urine. If this happens to you, your doctor will prescribe you a course of antibiotics to get rid of the infection.
What are the side effects?
As with all treatments, HIFU has a risk of side effects. The most common side effects of HIFU are urinary problems (urinary incontinence) and difficulty getting and keeping an erection (erectile dysfunction). Side effects will vary from man to man and there is no way of knowing which side effects you will get or how bad they will be. As HIFU is a fairly new treatment we do not have as much information about the risk of side effects as we do with some of the other treatments. We need more research to show us how many men are likely to get side effects from HIFU and how these will affect their every day life.
You are more likely to get side effects if you have repeat HIFU treatment or if you have already had other treatments for prostate cancer4. This is because these treatments may have already caused some damage to the tissue surrounding the prostate gland.
Ask your specialist team for more information on the risk of 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 have had the treatment.
HIFU can cause urinary problems. You may have symptoms straight after treatment (as described above), or you may develop urinary problems some time after treatment. Research suggests that if you have a large prostate, having a TURP operation before HIFU treatment may help reduce the risk of urinary problems2. This is because the TURP operation removes any parts of the prostate that are pressing on the urethra, making it easier to pass urine.
The results of individual studies vary, but about two out of 25 men (eight per cent) may have problems passing urine (urinary incontinence) after HIFU. Problems passing urine are more common if you have HIFU after external beam radiotherapy and may affect about three out of 10 men (30 per cent).4 You may find that you leak small amounts of urine when you cough, sneeze or exercise. Or you may need to pass urine more often or more urgently.
Some men may have longer term problems with a slow flow of urine. This may be caused by a narrowing of the urethra or the neck of the bladder and may affect about one out of ten men (10 per cent)4. If this becomes a problem, you may be offered a minor procedure to stretch the narrowed area.
Talk to your specialist team or GP if you have any of the side effects described above. There are a number of things that may help you to manage urinary problems, including lifestyle changes, pelvic floor muscle exercises and treatments. Your specialist team may be able to suggest some practical steps you can take to make things easier. They can also give you information about your local continence service. For information on how to manage urinary problems and how to get help, please read our page on Urinary problems and prostate cancer. You can also call our confidential Helpline.
Some men may have problems getting an erection (erectile dysfunction) after HIFU treatment. This is because HIFU can damage the blood vessels and nerves that control erections. Studies show different results for the number of men who experience this but it may be about nine out of 20 men (45 per cent)4.
After HIFU treatment some men may find that they ejaculate less semen, but are still able to experience orgasm (climax). Other men may have a dry ejaculation, where you feel the sensations of orgasm but do not release any semen. This may mean that you are not able to father children after treatment. If you are planning to have children, you may be able to store your sperm before the operation for use in fertility treatment. If this is important to you, ask your specialist team if this option is available locally.
If you have 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 is then passed out of the body the next time you pass urine. This is called retrograde ejaculation. It is not harmful and should not affect your enjoyment of sex but it may feel quite different from the orgasms you are used to.
For information about sexual problems after HIFU, speak to your specialist team. They can talk to you about possible treatment options for erectile dysfunction and can prescribe treatment free on the NHS. You can also ask your specialist team or your GP to refer you to your local erectile dysfunction (ED) clinic. Our page on Sex and prostate cancer has more information about sexual problems and possible treatments. You can also call our confidential Helpline.
Some men get a burning sensation or some bleeding from the back passage after HIFU treatment.2 Very rarely HIFU may cause a hole (fistula) between the urethra and the back passage. This affects less than one in 100 men (one per cent), however getting a fistula is a more common side effect in men who have already had radiotherapy. Recent studies suggest that about three out of 100 men (three per cent) who have HIFU after external beam radiotherapy may develop a fistula.4
What happens afterwards?
After your HIFU treatment you will have regular appointments with your specialist team to check your PSA level and monitor any side effects, such as problems passing urine and erection problems.
Your PSA is likely to reach its lowest level a few months after treatment.(2) If your PSA does not fall or if it starts to rise again, you may need to have a biopsy to see if cancer cells are present in the prostate gland. Scans may also sometimes be needed (such as a CT, MRI or bone scan) to find out if the cancer has spread to other parts of the body. If prostate cancer cells are present, your specialist team will talk to you about further treatment options.
Where can I get support?
As well as getting medical help to treat your cancer, you may find that it helps to talk to family or friends about how you are feeling. Sharing concerns can make any decisions about your treatment easier to deal with. You could also speak to your specialist team or call our confidential Helpline.
Partners and family also often worry about their loved one, and may find it helpful to talk to your specialist team.
Some people find that it helps to talk to other men who have had HIFU. There are prostate cancer support groups throughout the country. You can ask your specialist team for details, or or go to our support groups page.
We can also arrange for someone who has experience of prostate cancer to speak to you about making a treatment choice through our one-to-one support service.
If you have access to the internet, you can sign up to The Prostate Cancer Charity online community, where you can share your views and experiences with others affected by prostate cancer.
If you would rather speak to a professional counsellor, you can ask your GP if there is one available on the NHS or you can get a list of private counsellors from The British Association of Counselling and Psychotherapy.
Questions to ask your specialist team
- 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 and/or long term side effects with this treatment?
- 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 does not fall, or if it continues to rise, what other treatments are available?
The Prostate Cancer Charity
Call our free and confidential Helpline on 0800 074 8383 to speak to a specialist nurse. Our A - Z of Medical Words explains some of the words and phrases used on this page.
Bladder and Bowel Foundation
Provides information and support for all types of bladder and bowel related problems, for patients, their families, carers and healthcare professionals.
British Association for Counselling and Psycotherapy (BACP)
Gives information on what to expect from therapy and how to find a qualified counsellor.
Part of Cancer Research UK, Cancer Help provides information about all types of cancer and a database of cancer clinical trials.
Macmillan Cancer Support
Provides practical, financial and emotional support for people with cancer, their family and friends.
National Institute for Health and Clinical Excellence (NICE)
NICE produces recommendations on whether a treatment is suitable for use in the NHS.
Sexual Advice Association
Provides a helpline offering information about erectile dysfunction.
(1) NICE (2008) Prostate cancer: diagnosis and treatment. http://www.nice.org.uk/nicemedia/pdf/CG58FullGuideline.pdf
(2) Rebillard X, Soulie M, Chartier-Kastler E et al. High-intensity focused ultrasound in prostate cancer; a systematic literature review of the French Association of Urology. BJU Int 2008; 101 (10): 1205-13.
(3) Ahmed HU, Freeman A, Kirkham A et al. Focal therapy for localized prostate cancer: A phase 1 / 2 trial. J Urol. 2011;185(4):1246-55.
(4) Lukka H, Waldron T, Chin J et al. High-intensity Focused Ultrasound for Prostate Cancer: a Systematic Review. Clin Oncol. 2011; 23:117-127.
- Mr Simon Brewster, Consultant Urological Surgeon, Churchill Hospital, Oxford and Honorary Senior Lecturer, University of Oxford
- Sarah Buttle, Urology Nurse Specialist, Springfield Hospital, Chelmsford, Essex
- Natalie Mart, Urology Oncology Clinical Nurse Specialist, Royal Derby Hospital, Derby
- The Prostate Cancer Charity Support & Information Specialist Nurses
- Prostate Cancer Voices
Written and edited by:
The Prostate Cancer Charity Information Team
Last updated July 2011
To be reviewed July 2013