High intensity focused ultrasound (HIFU) for prostate cancer

HIFU is a treatment that uses high frequency sound waves to destroy prostate cancer cells. The waves create heat that destroys the cancer cells.

You might have HIFU for prostate cancer that hasn’t spread outside the prostate or that has come back in the prostate after treatment. It is only available in specific centres in the UK or as part of a clinical trial. 

What is HIFU?

HIFU is a treatment that uses high frequency sound waves. You have HIFU from a machine. The machine gives off sound waves which deliver a strong beam to the cancer. This heats up and destroys the prostate cancer cells.

Who can have HIFU?

The National Institute for Health and Care Excellence (NICE) recommends using HIFU for prostate cancer only in specific centres or as part of clinical trials. NICE is an independent organisation that provides guidance to the NHS to improve healthcare.

Your doctor might recommend HIFU if your cancer:

• is contained inside the prostate gland. This is localised prostate cancer
• is just breaking through the covering of the prostate. This is locally advanced prostate cancer
• has come back after earlier treatment. This is salvage treatment

You can’t have HIFU if your cancer has spread to other parts of your body. This is metastatic or advanced prostate cancer.

You might have HIFU treatment to either:

• the whole prostate gland. This is whole prostate HIFU
• specific areas of the prostate gland. This is focal HIFU

Before your treatment

Check your appointment letter for any specific ways to prepare for HIFU. You have HIFU treatment at the hospital as an outpatient. This means you can usually leave on the same day that you have HIFU.

You might have an MRI scan before the treatment. This is to find the exact position of the cancer so doctors can plan your treatment.

You have an enema to empty your bowels. An enema is a liquid filled pouch with a nozzle that you put into your back passage (anus). This causes you to empty or bowels. Or you take a laxative drink.

You usually need to stop eating for 6 hours before the procedure but can still drink fluids. You stop drinking 4 hours beforehand.

Your doctor asks you to sign a consent form to say that you agree to have the treatment. This is a good time to ask all the questions that you have.

You change into a hospital gown before the procedure.

During HIFU

You have HIFU in the operating theatre under general anaesthetic. This means that you are asleep and won’t feel anything. You have a small tube (cannula) put into a vein in the back of your hand.

Your surgeon puts a thin tube into your bladder through the urethra. The urethra is the tube that carries wee (urine) from the bladder out of the body. The tube drains your urine. It is called a urinary catheter.

Your surgeon puts a HIFU probe into your back passage (rectum). This probe gives out high intensity ultrasound waves that can destroy the cancer cells in your prostate. The high intensity ultrasound waves travel through the back passage to the prostate. 

The probe also works as an ultrasound and makes a picture on a screen. This shows your surgeon where they need to target. They move the HIFU probe around to treat all of the cancer cells.

Whole prostate HIFU treatment takes about 3 hours. HIFU to a smaller area (focal HIFU) takes 1 to 2 hours. 

When you are fully awake you go back to the ward to rest. The nurses check on whether you have any pain and will give you painkillers if you need them.

After your treatment

When you have recovered from the anaesthetic you can go home, usually on the same day. You won’t be able to drive home after the general anaesthetic. This is because it takes some time for the anaesthetic to wear off.

You might have a catheter for up to a week to drain urine. If you go home with a catheter your nurse will teach you how to care for it. They will arrange for it to be removed.

Side effects

Your doctor explains all the potential side effects to you before you sign the consent form.

All treatments have side effects and it’s important that you know about them before HIFU. You might have some of these side effects.

Pain

You might have pain in the area between your testicles and back passage (rectum). You can take painkillers to help.

Blood in your urine

You might have some blood or small pieces of prostate tissue in your urine. This can last for a few weeks.  

Erection problems

At first you might have difficulty having or keeping an erection. For many men this goes back to normal. Treatments can help with erection problems.

Urine infection

Signs of a urine infection include pain passing urine or feeling cold or shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 38°C. Severe infections can be life threatening. 

Problems passing urine

You might have problems passing urine if the prostate swells after HIFU. The swelling can block the urethra (the tube carrying urine from your bladder to outside your body). This might happen straight after removing your catheter. It is called urinary retention.

You might need to have a catheter for a short time to drain the urine.

You doctor may suggest that you learn how to put in a catheter to drain your urine at home. This is called self catheterisation. You take the catheter out when the bladder is empty. Your nurse will teach you how to do this.

Infection in your testicles

Infection can start in the small tubes that carry sperm from the testicles. You might have:

• swelling in one or both of your testicles
• pain or tenderness in one or both of your testicles

Tell your doctor or nurse if you have swelling or pain. You might need antibiotic tablets.

Long term side effects

Possible long term side effects include:

• erection problems
• loss of control of urine (urinary incontinence)
• problems passing urine due to blockage of the urethra
• a hole between the bladder and the back passage – this is rare

HIFU and clinical trials

HIFU is not available in every hospital. Your doctor might offer you HIFU treatment as part of a clinical trial. Or you might need to travel to specialist centre for treatment.