HIFU is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. It is usually used for prostate cancer that has returned after an initial treatment such as radiotherapy it is termed a salvage treatment. When high frequency sound waves are concentrated on body tissues, those tissues heat up and die.
HIFU is performed by inserting a probe similar to the probe used to take a prostate biopsy into the rectum. The probe will identify the prostate gland and the ultrasound waves can be targeted at the cancerous tissue. It usually takes around 3-4 hours to perform under a general anaesthetic. Some men with a prostate that is over 50 mls in size may not be suitable for HIFU.
After the treatment
- Men will have a urinary catheter (see surgery) which will need to stay in place for up to a week
- Men will need to avoid strenuous activity for a few weeks while their body heals.
- Men may have some blood in the urine for several weeks after the treatment.
- Very rarely, damage can occur to the back passage (fistula) that may require surgery.
Catheters and Catheter care
A catheter is a plastic tube that drains urine from the bladder. It will be connected to a drainage bag. The catheter is held inside the bladder by a balloon that is inflated with sterile water following insertion. It will therefore not usually come out unless properly removed by deflating the balloon. The balloon of the catheter tends to rest over a sensitive area of nerves in the bladder which may become irritated by its presence. This irritation may make a man feel as if he is bursting to pass urine and sometimes the nerves in the bladder will react to this irritation and force a small amount of urine to be expelled from around the catheter.
- Unless instructed otherwise men can have a shower or bath with the catheter in place.
- Do not use powders or lotions around the catheter or penis entry site.
- If men find the catheter is leaking they should not put non sterile materials around the penis.
- It is very important to drink 2 – 3 litres of fluid daily to flush the urine through and water based drinks tend to prevent bacteria forming in the urine which can lead to infection.
- When emptying or connecting catheter bags men should always wash their hands thoroughly with soap and water before and after the procedure.
- Do not pull or tug at the catheter.
Possible long term side effects
There can be a higher risk of erection problems (erectile dysfunction) after HIFU when it is used as salvage treatment in this way due to the effects of previous prostate cancer treatment. For information on managing erection problems please click here Risk of these problems appear to be comparable with other types of treatment such as radiotherapy and surgery when it is used as an initial or focal treatment to treat an area of the prostate rather than the whole gland.
A small number of men may develop a blockage of the urethra following HIFU and may need to have an operation called a Transurethral Resection of the Prostate Gland (TURP).
If the prostate gland is large prior to HIFU treatment a TURP may be performed before the treatment is given. Following HIFU men will be reviewed in clinic with a PSA blood test on a regular basis.
In the UK HIFU has been used as a salvage treatment for recurrent prostate cancer and is not usually used to treat early localised prostate cancer. It is also not widely available throughout the UK and may only be available at specialist centres.
The National Institute for Health and Care Excellence (NICE) currently support the use of HIFU to treat localised prostate cancer either as part of a clinical trial provided that men who undergo treatment realise that long term results comparable with surgery or radiotherapy are not available.
NICE has issued guidelines for using HIFU as a treatment for localised prostate cancer. These can be viewed on the NICE website.
Further information on HIFU treatment can be found below.
Last reviewed April 2021. Next review 2022.
References available on request.