What is HIFU treatment?

High intensity focused ultrasound (HIFU) is sometimes used as a treatment for early prostate cancer or prostate cancer that has come back after radiotherapy. It is given as part of a clinical trial, so it is only available in some hospitals in the UK.

HIFU treatment is given under a general or spinal anaesthetic. A probe is gently passed into the back passage (rectum). The probe makes a high-energy beam of ultrasound. This heats the affected area of the prostate and destroys the cancer cells. The probe is surrounded by a cooling balloon. This means the high-energy beams are only given to the areas with cancer in them and normal prostate tissue is protected.

Focal therapy

HIFU can be given to the whole prostate when there might be cancer in more than one area, so that all areas of cancer are treated.

But it may also be used for men who only need treatment to one small area of cancer in the prostate. Doctors call this focal therapy. It takes less time than whole-prostate treatment. It may also cause fewer side effects, because less of the healthy tissue is damaged.

You may have an MRI scan and several samples of prostate tissue taken (called a template biopsy). This will give the doctors a clear picture of where the cancer is in the prostate.

You may also have a prostate biopsy. This gives your doctor more information about the grade of the cancer. Areas of cancer that are shown to have a high risk of growing quickly will be given focal HIFU. But if the biopsy shows some areas to be very slow-growing, these may not be treated. This may mean you have fewer side effects.

After HIFU treatment, you will have regular PSA blood tests. If your PSA level is still high, you will be offered a different type of treatment, such as radiotherapy or surgery.

Side effects of HIFU for prostate cancer

Urine infections

Some men may get a urine infection after this treatment. You should contact your doctor if you:

  • have a high temperature
  • have a burning feeling when you pass urine (pee)
  • have urine that is dark in colour or cloudy
  • need to pass urine more often than usual.

Your doctor will usually prescribe antibiotics if you have a urine infection.

Urinary retention

This happens when you cannot empty your bladder properly after your 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, you should talk to your doctor or nurse.

If you are not able to pass urine at all, contact your doctor or nurse straight away or go to your nearest emergency department (A&E). Your bladder may need to be drained using a catheter.

Testicle infection

You may get an infection in the testicle or in the tubes that carry sperm from the testicle. You should talk to your doctor or nurse if your testicles are:

  • painful
  • swollen
  • tender to touch.

Testicle infections can usually be treated with antibiotics.

Possible late effects of HIFU for prostate cancer

Erection problems

HIFU for prostate cancer can cause problems getting an erection (called erectile dysfunction or ED). Your age and taking hormonal therapy can also affect this.

ED problems may not happen straight after treatment. They can develop slowly after treatment, over 2 to 5 years. Ask your cancer doctor about your risk of ED. There are different treatments that can help if you have ED.

Bladder problems

Urine leaking from the bladder (urinary incontinence) can be a side effect of having HIFU treatment. This is more likely if you have already had external-beam radiotherapy. Most men have some incontinence when their catheter is first removed. This usually improves within a few months of having your operation.

Some men may still be incontinent when they cough, sneeze or exercise. This is called stress incontinence. Other men may have problems needing to pass urine straight away (urgency). You will be encouraged to do exercises to strengthen the pelvic floor muscles. You can do these at home. The Bladder and Bowel Community can give you more information on how to do these exercises.

If you are having problems with incontinence, talk to your doctor or nurse. They can refer you to a continence team, who can give you advice about coping.

HIFU can cause narrowing in the urethra (urethral stricture). The urethra is the tube that runs from the bladder to the tip of the penis. It takes urine away from the bladder. If this happens, you may find it difficult to completely empty your bladder. If you are having problems passing urine, talk to your doctor or nurse.

Rectal fistula

Rarely, HIFU can damage the structures surrounding the prostate and a hole develops between the rectum (back passage) and the urethra. This is called a rectal fistula. Talk to your doctor if you have:

  • pain in your pelvis or back passage
  • urine coming from your back passage
  • poo (stools) in your urine.

If you have a rectal fistula, you will need an operation to repair it.

Treatment before HIFU

Some men whose prostate gland is enlarged may have some other treatments before HIFU:

  • Hormonal therapy. This can help to reduce the size of the prostate and make the cancer easier to treat.
  • Transurethral resection of the prostate (TURP). This is a small operation that helps improve the flow of urine before you have HIFU. Improving the flow of urine means you may have fewer bladder problems after HIFU.

 

About our information

  • References

    Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    European Association of Urologists. Guidelines on Prostate Cancer. 2016.

    European Society for Medical Oncology. Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. 2015.

    National Institute for Health and Care Excellence (NICE). Prostate cancer overview. Available from: pathways.nice.org.uk/pathways/prostate-cancer (accessed from March 2017 to November 2017).

    National Institute for Health and Care Excellence (NICE). Surveillance report 2016. Prostate cancer: diagnosis and management (2014). NICE guideline CG175. 2016.



  • Reviewers

    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 Lisa Pickering, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.


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