What to know about HIFU for prostate cancer

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HIFU is a fairly new treatment that doctors sometimes use to treat the following:

• early stage prostate cancer
• prostate cancer that has come back after other treatments

It is a technique that uses focused ultrasound waves to heat and destroy cancer cells in the prostate gland.

The procedure involves a surgeon inserting a probe into the rectum. The probe emits ultrasound waves directed precisely at the prostate tissue.

The high frequency waves create intense heat that destroys cancerous cells without harming the surrounding healthy tissue. This approach is minimally invasive and reduces the risk of damage to nearby parts of the body, such as the bladder and rectum.

A surgeon typically performs HIFU under general or spinal anesthesia. Depending on the size of and location of the tumor, the procedure may take around 1 to 4 hours.

HIFU may not be suitable for everyone.

At this time, some expert groups in the United States do not recommend HIFU as a first-line treatment for prostate cancer. This is due to the lack of data about the long term effects of HIFU compared with other conventional treatment options for prostate cancer.

People who may be eligible include those who have:

• early stage or localized prostate cancer (stages 1 and 2)
• locally advanced prostate cancer (stage 3)
• cancer that has come back after initial treatments such as radiation therapy
• prostate-specific antigen (PSA) levels of 20 nanograms per milliliter or lower
• been seeking a focal therapy option to preserve surrounding tissue and reduce side effects

Who should not have HIFU?

Individuals who should not receive HIFU include those with:

• metastatic prostate cancer, which is cancer that has spread beyond the prostate
• a very large prostate gland, as the size may limit the effectiveness of HIFU
• a history of rectal surgery
• certain types of inflammatory bowel disease (IBD)

It is essential that people undergo a thorough evaluation by a healthcare professional to determine if HIFU is right for them.

A healthcare professional will consider a person’s overall health, cancer stage, and other factors.

HIFU offers several benefits compared with traditional prostate cancer treatments, such as surgery and radiation therapy.

These advantages include:

• Minimal invasiveness: HIFU is a minimally invasive, nonsurgical procedure that does not require incisions, reducing the risk of infection and minimizing recovery time.
• Precision: The focused ultrasound waves target only the cancerous tissue, sparing healthy surrounding tissue and preserving regular prostate function.
• Fewer side effects: HIFU has a lower risk of side effects such as urinary incontinence and erectile dysfunction (ED) compared with other treatments such as radical prostatectomy and radiation therapy.
• Repeatable: A doctor can repeat the procedure if necessary, offering an option for people with recurrent prostate cancer.
• Outpatient procedure: Doctors may carry out HIFU treatments on an outpatient basis, allowing people to return home the same day.

While HIFU is generally well-tolerated, like any medical procedure, it carries some risks and potential side effects.

These may include:

• Pain: People may experience discomfort in the treatment area.
• Blood in the urine: This side effect might be present for a few weeks after treatment.
• Urinary symptoms: This can include feeling the need to urinate often or having difficulty urinating. There is also a higher risk of a urinary tract infection (UTI). In some cases, urinary retention may occur.
• ED: Although less common than with surgery, some individuals may still experience ED following HIFU treatment.
• Rectal fistula: This is a rare but serious complication where an atypical connection forms between the end of the bowel and the skin near the opening of the anus.
• Infection: There is a small risk of infection at the site where a doctor inserts the probe.

People need to discuss these potential risks with a healthcare professional to fully understand the implications of HIFU treatment for their specific situation.

Recovery from HIFU is typically quicker and less demanding than recovery from more invasive procedures.

Most people can resume their usual activities within a few days. However, individuals may need to avoid strenuous activities and follow any specific instructions their doctor recommends after the procedure.

Regular follow-up appointments are necessary to monitor PSA levels and assess the effectiveness of treatment.

HIFU and radiation therapy are both treatment options for localized prostate cancer, but they differ significantly in their approach and possible side effects:

• HIFU: This minimally invasive option uses focused ultrasound waves to heat and destroy cancer cells. It only targets cancerous tissue, reducing the risk of certain side effects associated with traditional therapies. It is an outpatient procedure with a short recovery time.
• Radiation therapy: This option uses high energy radiation to kill cancer cells. Doctors can deliver it externally (external beam radiation) or internally (brachytherapy). Radiation therapy typically occurs over several weeks and can cause side effects such as:
  • fatigue
  • skin irritation
  • more prolonged urinary and bowel symptoms

The American Cancer Society notes that it is still unclear how the long-term effects of HIFU compare with those related to radiation therapy for prostate cancer.

Some experts do not consider HIFU a first-line treatment for prostate cancer. Some healthcare professionals may consider HIFU after radiation therapy.

Ultimately, the choice between HIFU and radiation therapy depends on various factors, including the person’s overall health, cancer stage, and personal preferences. Individuals will need to consult a healthcare professional to help them determine the best option for their situation.

Learn more about radiation for prostate cancer.

Coverage for HIFU treatment can vary depending on the insurance provider and specific policy.

Medicare can offer coverage for HIFU for prostate cancer if it is medically necessary and supported by the person’s clinical condition.

People with insurance will need to check with their provider to understand their coverage options and any potential out-of-pocket costs associated with HIFU treatment for prostate cancer.

High intensity focused ultrasound (HIFU) is a promising treatment option for individuals with localized prostate cancer.

By using focused ultrasound waves to target and destroy cancer cells, HIFU provides a precise and effective alternative to traditional treatments such as surgery and radiation therapy. Healthcare professionals consider HIFU minimally invasive compared with traditional treatments.

As with any medical procedure, it is crucial for people to discuss the potential benefits and risks with a healthcare professional when making an informed decision about their treatment options. HIFU may not be suitable for all individuals with prostate cancer.