United Kingdom
Change

Support and offers for individual members and customers

Health Information

High intensity focused ultrasound (HIFU) treatment for prostate cancer

Published by Bupa's health information team, February 2008.

This factsheet is for men considering having high intensity focused ultrasound (HIFU) treatment for prostate cancer. HIFU uses ultrasound energy to heat and destroy cancer cells in your prostate.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About HIFU
What are the alternatives?
Preparing for your procedure
About the procedure
What to expect afterwards
Recovering from HIFU treatment
What are the risks?
Further information
Questions and answers
Related topics
Sources

About HIFU

The prostate is a gland that produces the liquid part of semen. It's about the size of a walnut and lies at the base of your bladder close to your rectum. Your prostate surrounds your urethra, the tube that carries urine from your bladder and out through your penis. Sometimes the cells in your prostate can become uncontrolled and overgrow. The condition can be malignant (cancerous) or benign (benign prostate hyperplasia). Any change in the size or shape of your prostate can push on your urethra and make it difficult to pass urine.

This illustration shows the position of the prostate gland and surrounding structures
The position of the prostate gland and surrounding structures

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

HIFU is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure. Alternatively you may prefer to have HIFU under regional anaesthesia. This completely blocks the feeling in your lower body but you stay awake.

Your anaesthetist will advise which type of anaesthesia is most suitable for you.

What are the alternatives?

The type of treatment you have for prostate cancer depends on your age, whether the cancer has spread, and if so how far. Alternative treatments include:

cryotherapy - liquid gas is used to freeze and kill the cancer cells in your prostate
surgery - your prostate is removed using open or keyhole surgery
radiotherapy - radiation is used to destroy cancer cells

Preparing for your procedure

Your surgeon will explain how to prepare for HIFU. For example, you may be given laxatives to take the evening before or on the morning of the procedure. These will help empty your bowel.

If you are having general anaesthesia you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine.

Your surgeon will usually visit you to discuss the procedure and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to HIFU, and have given your permission for it to go ahead.

Your bowel has to be completely empty, so you may have a bowel washout. This is when a tube is passed into your rectum and water is used to flush out faeces. A bowel washout isn't always necessary after having laxatives.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may also be taught how to self-catheterise, as sometimes it can be difficult to pass urine for a few days after HIFU.

About the procedure

HIFU usually takes one to three hours, depending on the size of your prostate.

Your surgeon will do a rectal examination to feel your prostate. Your surgeon will pass a lubricated probe (about the size of a tampon) into your rectum. Images of your prostate are displayed on a TV screen.

Your surgeon will examine your prostate and focus a high-energy ultrasound beam on the cancer cells to heat and destroy them. The images on the TV screen allow your surgeon to monitor how much tissue is destroyed.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will have a catheter (a fine tube) passed through your penis to drain urine from your bladder into a bag. This is usually left in place for three to 14 days.

Your surgeon will usually prescribe a course of antibiotics.

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

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

Recovering from HIFU treatment

Take it easy and drink fluids regularly for a few days after HIFU treatment to help flush out any possible infection. If you have been prescribed antibiotics, it's important that you complete the course.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

You will have some swelling around your scrotum and this should ease over a few days. It's normal to have some blood in your urine for up to eight weeks after HIFU. Contact the hospital or your GP if you develop:

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

What are the risks?

HIFU for prostate cancer is a relatively new treatment and is considered to be safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risks of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic. Common side-effects include:

soreness, swelling and bruising in your rectal area - this should ease quickly
swelling in your scrotum and penis - this can affect your ability to pass urine and will need a catheter
blood in your urine - this can last for up to eight weeks
a burning sensation on passing urine, or feeling the need to pass urine more frequently and urgently - this can last for six to eight weeks after the catheter is removed

Complications

This is when problems occur during or after the procedure. Most men are not affected. The possible complications of any procedure under general anaesthesia include an unexpected reaction to the anaesthetic or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of HIFU prostate treatment are listed here.

Urinary tract infection (UTI). The risk of infection is high for a few weeks so it's important that you complete your course of antibiotics.
Stress incontinence. The catheter can weaken your bladder muscles and there's a chance you may leak when you cough, sneeze or make a sudden movement. This should gradually improve after a few weeks.
Damage to the urethra or bladder. The catheter can damage your bladder or urethra and you may need further surgery.
Impotence. You may not be able to get or maintain an erection after HIFU treatment.

As with all treatments for prostate cancer, you will usually become infertile and you probably won't ejaculate.

Repeat HIFU treatment may be necessary if the cancer tissue is not completely destroyed, or if you have a recurrence.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Further information

Prostate UK
020 8877 5840
www.prostateuk.org
The Prostate Cancer Charity
0845 300 8383
www.prostate-cancer.org.uk