HIFU

High Intensity Focal Ultrasound

HIFU and Prostate Cancer

About HIFU

Today in the UK most men who are diagnosed with early-stage prostate cancer must choose between a risky surgical intervention (radical prostatectomy), Radiotherapy along with Brachytherapy, no treatment at all, or simply monitoring the disease.

In recent years a newer less invasive option called HIFU has provided a less invasive alternative which has been shown to greatly reduce the side effects associated with traditional treatments, such as incontinence and erectile dysfunction.

HIFU, which stands for high intensity focused ultrasound, eliminates cancer in the prostate with fewer complications by a process called ablation Ablation generates an accurate pinpoint of heat targeted at cancer cells within the prostate gland by focusing multiple ultrasound waves.

Surgeons can target and treat small amounts of tissue, minimising damage to nerves around the prostate responsible for preserving urinary continence and sexual function.

Prost8 UK have chosen the Sonablate HIFU system to deploy as part of our campaign.

How HIFU works

Sonablate is a medical device designed for precise ablation of prostate tissue using high intensity focal ultrasound (HIFU) energy

What is HIFU

High Intensity Focused Ultrasound (HIFU) is a remarkable, non-invasive procedure that treats prostate cancer while usually avoiding the two most common life-altering side effects seen with radical surgery and radiation – permanent bladder control problems and erectile dysfunction.

HIFU is the focusing of sound waves to create heat at a specific point. This is called the focal point.

This heat is used to destroy targeted tissue during an outpatient procedure, individually customised for each patient’s prostate cancer treatment.

How does it work?

Think about how a magnifying glass focuses light rays from the sun to a particular point and can burn a hole in a leaf.

HIFU works in much the same way. There is a transducer, which focuses sound waves to a particular point, creates heat and destroys tissue at that point. Nothing outside of the focal point is damaged.

What to expect

If you choose HIFU you will receive pre-operative instructions from a consultant and nurse.

The HIFU procedure typically lasts between 1-4 hours, depending on the size of the prostate, and is either done under general anaesthesia or an epidural and IV sedation.

During the procedure a catheter will be put into place through the penis to help with urination and will typically stay in place for 1-3 weeks.

After the HIFU treatment, patients will be in recovery for about 2-4 hours. Once released from the treatment centre, patients return home to recover more comfortably.

Sonablate HIFU

Prost8 UK have chosen to donate the most advanced HIFU treatment equipment as part of our campaign. For that reason, we have been guided by top specialists to select the Sonacare Sonablate unit, or equipment to similar standard.

Sonablate is a state-of-the art, non-invasive medical device that destroys tissue in the prostate using focused ultrasound.

This state-of-the-art technology consists of a console where the physician plans, monitors and adjusts HIFU treatment, a transrectal probe and a chiller, which is a safety device that keeps the rectum cool during treatment.

How HIFU treats the prostate

The device has highly sophisticated software that enables treating surgeons to obtain images of the prostate. The images are used to map out and target exactly where HIFU should be delivered.

Once a physician has targeted all the areas to be treated they deliver the HIFU energ while continually monitoring how the tissue reacts, adjusting as needed, for safe, effective delivery of HIFU energy.

Why choose HIFU

HIFU is a non-invasive, outpatient treatment option that allows men to return to their normal lifestyle in days, preserving patient quality of life.

The Sonablate is among the most sophisticated HIFU technology available for prostate tissue ablation.

The device incorporates customised treatment and safety technologies in an effort to strike a balance that has previously been difficult to achieve in prostate cancer treatment – increasing disease control capabilities, while decreasing quality-of-life side effects.

Who can have HIFU?

HIFU will provide literally thousands of men with the opportunity to receive less invasive treatment and retain maximum functionality (urinary continence and erectile function) ongoing.

The advantages of HIFU treatment for prostate cancer are superior to most current alternatives as it is usually a day stay procedure (you will go home the same day) with a short recovery time of one to two weeks.

HIFU is minimally invasive with no surgical requirement (just a needle in your hand for general anaesthetic). It can also be repeated should your cancer recur, and it does not exclude other treatments if required such as radiotherapy or surgery.

Unfortunately, HIFU is available in very few NHS hospitals right now but you can talk to your GP, consultant or nurse to see if it is available in your area.

Making HIFU available to men across the UK is the main driving force of Prost8 as a charity and our aim is to raise funds and campaign to deploy at least one unit in each of the 14 UK NHS regions.

Our ambition is high as each unit costs in the region of £500,000 but, if successful, our plan will achieve this within the next five years.

However, it is unlikely that HIFU will be offered as an alternative if the cancer has spread outside of the prostate to other parts of the body (advanced prostate cancer) although HIFU can be used in cases where the cancer has reoccurred after other treatments (recurrent prostate cancer) such as radiotherapy and is offered in these cases (salvage HIFU).

Side effects

As HIFU is relatively new knowledge about the long-term benefits and effects is increasing every day. Results from trials and early cases in the first five years are highly encouraging with lifestyle outcomes far better than most other traditional treatment options (such as radiotherapy and surgery).

The risk of side effects over a ten-year period are unknown but are expected to be better by the nature of the treatment as there is less damage to the prostate and surrounding organs and tissue.

More information about HIFU treatment

What does HIFU involve?

HIFU treatment is given as either whole-prostate HIFU (treats the entire prostate) or Focal HIFU (treats a smaller finely targeted area of the prostate). Your consultant will advise which type of HIFU is best suited to your condition.

Before treatment

If you have a large prostate you may be offered other treatments before you have HIFU. Sometimes your doctor will prescribe hormone therapy for several months to shrink the prostate and make treatment easier. Hormone therapy does come with side effects which will be explained at the time.

If you’re having focal HIFU you will usually go to a screening appointment first. You’ll have a magnetic resonance imaging (MRI) scan, which produces detailed images of the prostate and shows the location of the cancer. You may also have a prostate biopsy, which shows the location of the cancer and how likely the cancer is to grow and spread outside the prostate. These tests will help your surgeon target the area of the prostate that needs to be treated.

The day of treatment

You will be checked by a nurse upon arrival and given an enema to empty your bowels. This is a liquid that is put inside your back passage (rectum). You will have been advised not to eat or drink for several hours ahead of arrival.

Once ready to go to theatre you will be given a general anaesthetic (or an epidural if recommended by your doctor for health reasons). A catheter will usually be fitted ahead of treatment to control urine flow.

The HIFU treatment is delivered via a probe that is inserted into the back passage by your surgeon. The probe gives out a beam of high-intensity ultrasound energy, which travels through the wall of the back passage into the prostate. The beam treats one small area of the prostate at a time, about the size of a grain of rice. Your surgeon will move the beam around so that it heats and destroys the cancer cells.

The probe also uses ultrasound to create images of the prostate while your surgeon is treating it. This helps the surgeon target the cancer so that less of the healthy tissue is damaged. The probe is surrounded by a cooling balloon so that the heat doesn’t damage your back passage.

Following treatment

HIFU causes the prostate to swell initially which can make it difficult to urinate so a catheter will be fitted for the first week or so to drain urine until things settle down.

You may have pain in the peritoneal and rectal area after HIFU and you will receive pain-relieving drugs for this along with precautionary antibiotics to prevent possible infection. You may also be given a laxative to aid bowel movement.

Side effects

HIFU can cause short or longer-term side effects although these are rare and may include the following:

Urinary side effects:
Some men may experience some urine leakage after HIFU particularly after exercise or coughing. Some will experience issues with frequency of urination or starting and stopping but most of these symptoms settle down after a few weeks.

This is because the PSA blood test is not specific to prostate cancer. Your PSA level can also be raised by other, non-cancerous conditions.

Raised PSA levels also can’t tell a doctor whether a man has life-threatening prostate cancer or not.

If you have a raised PSA level, you may be offered an MRI scan of the prostate to help doctors decide if you need further tests and treatment.

Read more about PSA screening and testing in the UK