Like all treatments, HIFU can cause side effects. These will affect each man differently, and you might not get all of them.
The most common side effects are urinary problems and difficulty getting or keeping an erection (erectile dysfunction).
You’re more likely to get side effects if you have more than one HIFU treatment or if you’ve had other treatments for prostate cancer before HIFU. This is because your first treatment may have already damaged the area around your prostate.
Less of the healthy tissue is damaged during focal HIFU than whole-prostate HIFU so some experts believe it may cause fewer side effects than whole-prostate HIFU. But we need more research before we know if there is a difference in the risk of side effects.
If you have hormone therapy or a TURP before you have HIFU, these can also cause side effects.
Short-term side effects
These can develop soon after your treatment and may include:
Blood or tissue in your urine
You might see some blood in your urine while the catheter is in place. You might also see some small pieces of prostate tissue in your urine for six to eight weeks after HIFU. This is normal. If you are worried or see signs of an infection (see below), speak to your doctor or nurse straight away.
Some men have problems getting or keeping an erection (erectile dysfunction) after HIFU. This is because it can damage the blood vessels and nerves that control erections. For some men this will improve, but for others this will be a longer-term side effect of the treatment (see below). There are treatments that can help with erection problems.
Some men get a urine infection after HIFU. Signs of a possible urine infection include:
- a fever (high temperature)
- a burning sensation when you urinate
- dark or cloudy urine with a strong smell
- needing to urinate more often than usual.
Tell your doctor or nurse if you have any signs of a urine infection. They’ll usually give you antibiotics to treat the infection.
Some men find it hard to empty their bladder properly after their catheter is removed – this is called urine retention. This is because HIFU can cause the prostate to swell and block the urethra, which is the tube you urinate through. If your flow of urine is weak or slow after your catheter is taken out, speak to your doctor or nurse.
If you can’t urinate at all, call your doctor or nurse straight away or go to your nearest accident and emergency (A&E) department. They may need to drain your bladder using a catheter.
They might also suggest using a temporary catheter (self-catheterisation) until the swelling has gone. This is where you put a catheter in yourself when you want to urinate and take it out afterwards. Some men find that urinary problems improve over time but other men have longer-term problems.
Some men get an infection in the testicles or the tubes that carry sperm from the testicles. Signs of a possible infection include pain, swelling and tenderness in one or both testicles. Tell your doctor or nurse if you have any of these symptoms. They’ll usually give you antibiotics to treat the infection.
Longer-term side effects
Most side effects will settle down after HIFU, but some men have later or longer-term side effects, including:
Some men get erection problems that improve over time, but other men find that their erection problems don’t improve. There are treatments that can help manage erection problems.
You should still be able to orgasm (climax) after HIFU, but you might release less semen (the fluid that carries sperm), or no semen at all. This means you may not be able to have children naturally after treatment. If you’re planning to have children, you might be able to store your sperm before HIFU to use in fertility treatment. If this is important to you, ask your doctor or nurse about it.
You may find that when you orgasm, the semen travels backwards into the bladder rather than out through the penis. The semen is then passed out of the body when you next urinate. This is called retrograde ejaculation. This is more common if you’ve had a TURP before HIFU. It isn’t harmful and shouldn’t affect your enjoyment of sex, but it might feel different to the orgasms you’re used to.
Talk to your doctor or nurse if you have problems with erections or other sexual problems. They can explain your treatment options and arrange free treatment on the NHS. They can also refer you to an erectile dysfunction (ED) clinic.
Read more about sexual problems and how to manage them.
HIFU can cause longer-term urinary problems. You may have some of the following symptoms straight after treatment, or they might develop some time later.
- Some men leak urine (urinary incontinence) after HIFU. This is more likely if you’ve already had external beam radiotherapy.
- You may leak urine when you cough, sneeze or exercise (stress incontinence).
- If your urethra, which is the tube you urinate through, or the opening of your bladder becomes narrow (a stricture), you may find it difficult to empty your bladder.
- Some men need to urinate more often than usual (frequency).
- You may have a sudden urge to urinate (urgency).
Talk to your doctor or nurse if you have any urinary problems. They may refer you to an NHS continence service, run by nurses and physiotherapists who specialise in urinary problems.
Read more about urinary problems and how to manage them.
A hole between the back passage and the urethra (rectal fistula)
Very rarely, HIFU can cause a hole between the back passage (rectum) and the urethra, which is the tube you urinate through. This is called a rectal fistula. It affects fewer than 1 in 100 men who have whole-prostate HIFU (1 per cent). It is slightly more likely if you’ve already had radiotherapy.
Signs of a possible rectal fistula include:
- urine coming out of your back passage
- pain in your pelvis or back passage
- bowel contents in your urine
- air bubbles in your urine
- urine infections, although these can be caused by other things.
Talk to your doctor or nurse straight away if you think you may have a rectal fistula. If you develop a fistula, you will need an operation to repair the hole.