High Intensity Focused Ultrasound (HIFU)
In summer 2005, the National Institute for Health and Clinical Excellence (NICE) approved HIFU as a treatment for prostate cancer. But what does the treatment involve and it suitable for everyone? This article gives you the facts and asks a urologist and a man who has had the treatment for their experiences of HIFU.
- What is HIFU?
- Who can have HIFU?
- How does HIFU treat prostate cancer?
- What are the advantages and disadvantages?
- What are the side effects?
- What does treatment involve?
- What happens afterwards?
- Where can I find out more?
What is HIFU?
The idea of using ultrasound to destroy tissue has been around for decades but it is only relatively recently that this has been developed into a treatment for cancer. HIFU uses ultrasound energy to kill cancer cells in the prostate with minimal damage to the surrounding tissue. The treatment was approved for use in the NHS in March 2005 and is now available in several centres across the UK.
The results of HIFU have so far been promising but it is still early days and only a relatively small number of men have been treated using this technique. This means that, in comparison to other treatments, we know less about its long-term effects and effectiveness as a treatment for prostate cancer.
Who can have HIFU?
HIFU is one of a range of treatments for cancer that is contained within the prostate gland (localised). Alternatives include surgery, radiotherapy and brachytherapy. HIFU can be used as a first treatment and can be repeated if needed. It can also be used as a ‘salvage’ treatment if radiotherapy fails to control the cancer. HIFU is not suitable for treating large prostates so some men may need hormone therapy first to try to shrink the gland.
How does HIFU treat prostate cancer?
An ultrasound probe releases a beam of high-intensity ultrasound through the back passage (rectum) into the prostate gland. The beam increases the temperature of the area that it is focused on, without affecting any tissue that it passes through. This increase in temperature destroys the cells in that area.
The back passage is kept cool to prevent any damage from the heat. However, previous radiotherapy treatment can thicken the wall of the back passage in some men. This makes it more difficult to protect against the heat and can increase the risk of severe side effects. If you have had radiotherapy and are considering HIFU as a second treatment, speak to your specialist team about this.
What are the advantages and disadvantages?
Advantages
- The treatment can be repeated
- Other treatments, such as radiotherapy, can be used afterwards if needed.
Disadvantages
- It is not suitable for treating cancer that has spread outside the gland (locally advanced or advanced)
- If any cancer cells are present in the area just outside the gland (locally advanced) they will not be treated, whereas radiotherapy does treat cells in this area.
What are the side effects?
HIFU is a relatively new treatment so we don’t yet know the long-term effects. However, results so far have shown that side effects are less common than after surgery or radiotherapy. Possible side effects include:
- Problems getting and maintaining an erection (erectile dysfunction or ED). Some studies estimate that between three and seven out of every ten men get this side effect. The risk is greater if you had problems before treatment.
- Leakage of urine when you cough, sneeze or move suddenly (stress incontinence). This usually improves over a short time.
- A small number of men (less than one in 100) get a join between their back passage and the tube that carries urine out of the body (urethra). This is called a ‘fistula’.
- Between two and five out of every 100 men get a narrowing of the urethra (stricture).
What does treatment involve?
You will go into hospital either the day before or on the day of the treatment. The whole procedure lasts around three hours and you can go home the following day. Some men will first need to have a small operation (called a TURP) to remove some of the prostate and prevent any problems with passing urine.
After having a general or spinal anaesthetic, the HIFU probe will be gently inserted into the back passage. The computer maps the outline of the prostate gland and the treatment then starts. The probe releases short burst of ultrasound to a small targeted area of the prostate. The target is then moved to the next area of prostate and the process is repeated until the whole gland has been treated.
You will have a catheter for a few days afterwards to help you to pass urine until any swelling has gone down. You may notice a small amount of blood and debris and you may need to pass urine more often or more frequently once the catheter is removed. This should clear up after a few weeks.
What happens afterwards?
Your PSA level will be checked regularly after treatment. Your PSA should fall to its lowest level quite quickly but if it does start to rise again you can have HIFU again or you may prefer another treatment such as radiotherapy.
Where can I find out more?
Speak to your specialist team about your treatment options and the availability of HIFU in your area. You can also call our confidential Helpline on 0800 074 8383 to find out which hospitals are offering the treatment. Read our Tool Kit for details of other available treatments and side effects.
The National Institute for Clinical Excellence (NICE) has published NICE guidelines on HIFU.
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