High-intensity focused ultrasound (HIFU) treatment

High intensity focused ultrasound (HIFU) is a treatment that is sometimes used to treat early prostate cancer or prostate cancer that has come back.

What is high-intensity focused ultrasound (HIFU) treatment?

High-intensity focused ultrasound (HIFU) treatment is sometimes used to treat early prostate cancer (usually low-risk) or prostate cancer that has come back after radiotherapy or brachytherapy.

Unfortunately, this treatment is not routinely available in all NHS hospitals. It is important to talk to your specialist doctor and nurse first to find out if a treatment is available in your area. Usually you can only have HIFU on the NHS as part of a clinical trial.

Some private clinics also offer this treatment. HIFU treatment is not suitable for everyone. It depends on where the cancer is in the prostate and the risk group of the cancer. Your doctor can explain more about this.

When is HIFU treatment used?

HIFU can be used to treat the whole prostate gland when the cancer is in more than one area. It is also used when there is only one small area of cancer in the prostate gland (focal therapy).

If there are areas of cancer that are growing quickly (high grade) you can have focal treatment to these. Very slow-growing areas of cancer may not be treated. You may have fewer side effects because less healthy tissue is damaged.

If the cancer comes back after HIFU treatment, you may still be able to have treatment with surgery or radiotherapy. You will have your PSA level checked regularly after treatment.

How is HIFU treatment given?

You have HIFU under a general anaesthetic or a spinal anaesthetic. You can usually go home when you have recovered from the anaesthetic.

The surgeon passes a probe into the back passage (rectum). It produces beams of high-energy ultrasound that heats and destroys the area of prostate cancer cells. The probe is surrounded by a cooling balloon so the high-energy beams are only given to the areas with cancer. This means the normal prostate tissue is protected.

Side effects of HIFU treatment

Urinary problems

You may have problems passing urine (peeing).

To prevent this, the surgeon puts a tube (catheter) into your bladder to drain urine into a bag. It is left in for 1 to 2 weeks. You are likely to have some urine leaking from the bladder (incontinence) when the catheter is first removed, but this usually improves within a few months.

You may also have problems needing to pass urine straight away (urgency). Doing regular exercises to strengthen your pelvic floor muscles can help to improve your bladder control.

Sometimes a TURP operation is done before HIFU to reduce bladder problems afterwards.

  • Urinary retention

    This happens when you cannot empty your bladder properly after the catheter is removed. HIFU can cause the prostate to swell. This may block the tube from the bladder that urine passes through (urethra). If your urine flow is weak or very slow, tell your doctor or nurse. If you cannot pass urine at all, contact your doctor or nurse straight away or go to your nearest emergency department (A&E).

  • Long-term urinary problems

    Some people may have long-term urinary problems such as leakage (incontinence) after HIFU. This is more likely if you have already had external beam radiotherapy. Another late effect of HIFU can be a narrowing in the urethra (urethral stricture). If you are having problems passing urine, talk to your doctor or nurse.

Pain and bleeding

You may have some pain in your lower tummy or back passage (rectum). You will be given painkillers for this. You may have some bleeding from the back passage.

Erection problems

HIFU can cause problems getting an erection. This is called erectile dysfunction (ED). ED may not happen straight after treatment. It can develop slowly, over 2 to 5 years.

Rectal fistula

Rarely, HIFU can damage tissues surrounding the prostate and cause a hole between the rectum (back passage) and the urethra. This is called a rectal fistula. If you have a rectal fistula, you will need an operation to repair it.

We have more information about fistulas.

Possible benefits and disadvantages of HIFU

If you are thinking about having HIFU, your doctor can explain the benefits and disadvantages. They will also tell you about the other treatment options available to you.

Doctors still do not know enough about how effective HIFU treatment is compared to existing treatments for early prostate cancer. Active surveillance, which involves monitoring the cancer, may be an option.

Side effects, such as erection difficulties and urinary problems may be less of a problem with these treatments. But they may still affect you. If you have already had treatment for prostate cancer, the side effects may be worse.

Some people may prefer to have HIFU even though there is not enough evidence about them yet. They may feel there is less risk of certain side effects and want to avoid surgery or radiotherapy. Or, it may be because these treatments can be given in a short hospital stay and recovery is usually quick.

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    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Ursula McGovern, Consultant Medical Oncologist.

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