Prostate cancer - high intensity focused ultrasound treatment (HIFU)

About HIFU

HIFU treatment uses high frequency ultrasound energy to heat and destroy cancer cells in your prostate gland.

Currently, HIFU is only used as part of clinical trials for men with localised prostate cancer (cancer that hasn’t spread outside of the prostate). This is because there isn't enough evidence on quality of life and long-term survival (beyond five years) for HIFU, in comparison with other treatments. The National Institute for Health and Clinical Excellence (NICE) is therefore unable to recommend it as a routine treatment.

If you have an enlarged prostate and your urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system) recommends you for HIFU, you may be offered another type of treatment beforehand to shrink the gland. For example, you may be given hormone therapy, or a procedure called transurethral resection of the prostate.

What are the alternatives to HIFU?

The type of treatment you have for prostate cancer depends on whether the cancer has spread, and if so, how much. If you're invited to take part in a clinical trial for HIFU, your surgeon will make sure you're aware of the other treatment options that are available. 

Alternative treatments for prostate cancer include the following.

  • Watchful waiting. This involves monitoring the cancer, but not treating it unless it grows.
  • Surgery. Your prostate may be removed using either open or keyhole surgery.
  • Radiotherapy. This is where radiation is used to destroy cancer cells.
  • Brachytherapy. This involves having small, radioactive seeds put into your prostate. There is also high-dose rate brachytherapy, in which radiation is put into your prostate for a few minutes at a time.
  • Cryotherapy. Liquid gas is used to freeze and kill the cancer cells (but is only offered as part of a clinical trial).

Chemotherapy, which uses medicines to destroy cancer cells, and hormone therapy can be used to treat more advanced forms of prostate cancer.

Preparing for HIFU

Your surgeon will explain how to prepare for the procedure.

You may be given an enema the evening before, or the morning of the procedure. An enema is where a liquid is injected into your rectum (back passage) to empty your bowel.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

HIFU is usually done as a day-case procedure under general anaesthesia. This means you will be asleep during the procedure. If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

Alternatively, you may be given a spinal, or epidural, anaesthetic injection. This completely blocks feeling from your waist down and you will stay awake during the procedure. If you have this type of anaesthetic, your surgeon may give you a sedative as well, to help you to relax. Your anaesthetist will let you know which type of anaesthesia is most suitable for you.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

What happens during HIFU

HIFU takes up to three hours, but this depends on the size of your prostate and how much of it is being treated.

Your surgeon will pass a lubricated probe into your rectum. The probe gives out a beam of ultrasound, which your surgeon will focus so that it heats and destroys the area of prostate tissue where there is cancer. The probe will have a cooling balloon around it to protect nearby areas from the high temperature.

What to expect afterwards

You may need to rest until the effects of the anaesthetic have passed. If you had a spinal anaesthetic, you may not be able to feel or move your legs for several hours afterwards. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will have a catheter, which is a fine tube that is passed through your penis or abdomen (tummy) to drain urine from your bladder into a bag. This may be left in place for up to two weeks, but this can vary.

You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Before you go home your nurse will give you a follow-up appointment and some advice about caring for your catheter.

Your surgeon may prescribe a course of antibiotics to help prevent you developing an infection.

Recovering from HIFU

If you’ve been prescribed antibiotics, it's important to complete the full course.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

What are the risks?

As with every procedure, there are some risks associated with HIFU. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Common side-effects include:

  • blood in your urine when you have a catheter in place
  • difficulty passing urine once the catheter has been removed, because of swelling in your prostate
  • passing some of the destroyed prostate tissue and blood, which may be uncomfortable, in your urine

Contact the hospital or your GP if you have:

  • increasing pain, or pain that can't be controlled with painkillers
  • a high temperature
  • increased blood in your urine
  • difficulty passing urine

Complications

Complications are when problems occur during or after the procedure. The possible complications of HIFU treatment are:

  • a urinary tract infection – the risk of infection is high for a few weeks, so it's important to complete the full course of antibiotics
  • stress incontinence – your urethral muscles can become weakened, so you may leak some urine when you cough, sneeze or make a sudden movement, but this is rare
  • impotence – you may not be able to get or maintain an erection after HIFU treatment
  • infertility – your fertility may be affected
  • damage to your rectum (back passage) – this can cause a burning feeling or bleeding from your rectum, but is very rare

It’s important to remember that surgeons may not yet know about all the side-effects and complications of HIFU treatment. Speak to your surgeon for more information.

Can high intensity focused ultrasound (HIFU) cause impotence?

Answer

A potential complication of HIFU treatment for prostate cancer is impotence. 

Explanation

When you have HIFU treatment, ultrasound energy is used to heat and destroy cancer cells in your prostate gland. The ultrasound energy can sometimes damage the nerves and blood vessels that control your erections. This means that you may not be able to get or maintain an erection after your treatment.

There are treatments available if you have impotence after HIFU treatment. Speak to your GP for more information.

Is it painful to have the catheter removed after HIFU treatment?

Answer

You may feel slight discomfort when the catheter is removed. 

Explanation

HIFU treatment for prostate cancer can cause inflammation and swelling of your urethra (the tube that carries urine from your bladder and out through your penis), which can make it difficult to pass urine.

You will have a thin tube called a catheter fitted to drain urine from your bladder into a bag. This may be passed through the urethra in your penis into your bladder and left in place for a up to two weeks. Alternatively, you may have the catheter placed directly into your bladder through a small cut in your lower abdomen (tummy).

You will be given an appointment at the hospital to have your catheter removed. You may feel slight discomfort when the catheter is removed but it shouldn't be painful.

Can HIFU treatment affect bladder control?

Answer

It's possible that you may have urinary incontinence for a few weeks after the catheter is removed, but this is uncommon. 

Explanation

If you have HIFU treatment, it can cause inflammation and swelling of your urethra (the tube that carries urine from your bladder and out through your penis), making it difficult for you to pass urine. Because of this you will have a thin tube called a catheter in place for up to two weeks after the procedure. The catheter will drain urine from your bladder into a bag.

The catheter can weaken your bladder or urethral muscles and there is a chance you may leak urine when you cough, sneeze or make a sudden movement after it is removed. This is called stress incontinence. You may also feel the need to pass urine more frequently and urgently, which is known as urge incontinence. These symptoms should gradually improve. If you’re having symptoms of either type of incontinence, speak to your surgeon for advice.