A look at the use of high intensity focused ultrasound hifu in prostate cancer treatment

Due to the risk of unwanted damage to healthy prostate cells when using traditional treatment methods such as prostate brachytherapy and chemotherapy much research is carried out to develop new methods to treat prostate cancers. One of the newer methods that has been developed to treat early stage prostate cancers is high intensity focused ultrasound, this is commonly abbreviated to HIFU.

In high intensity focused ultrasound treatments, high energy is delivered to the affected area by ultrasound, this results in the targeted cancerous cells heating up and being destroyed.

How is the ultrasound delivered to cancerous prostate cells?

The high intensity focused ultrasound is delivered through a probe; this is inserted into the rectum. The use of low energy diagnostic ultrasound from the probe enables the doctor to get an accurate picture of the prostate. The area that needs to be treated can then be targeted accurately and subjected to the high energy ultrasound beam.

What is the patient experience during HIFU?

HIFU for prostate cancer treatment is often given as an outpatient treatment and takes a few hours to perform. The patient is first given an anaesthetic. The probe is inserted via the rectum, additionally a rectum balloon filled with a cold circulating liquid is also inserted into the rectum; this is to prevent heat damage to the rectum from the HIFU treatment.

Initially the doctor will scan the prostate using diagnostic ultrasound; he/she will then remove the probe and replace the probe head with a high intensity focused ultrasound firing head. The use of a computer program then enables the doctor to aim the ultrasound at the area of the prostate that has cancer, whilst avoiding damage to the rectum.

Typically the ultrasound will be fired for a few seconds at a time, and then a similar period of rest will be given before firing at the next targeted area or layer of the prostate. Following the procedure most patients are allowed to return home but may temporary require a catheter.

How effective is high intensity focused ultrasound

The use of high intensity focused ultrasound HIFU is quite effective with around 90% of people treated with the method having no sign of cancer in biopsies taken following the procedure. After 5 years over two thirds of people treated are cancer free. The levels of PSA drop dramatically following this form of treatment. It may sometimes be necessary to take treatments in conjunction with focused ultrasound such as external radiation or hormone treatment.

Advantages and disadvantages of high intensity focused ultrasound

Some of the advantages of high intensity focused ultrasound are that it is able to be repeated if cancer reappears; it can destroy cancer in targeted areas of the prostate without destroying other areas of the prostate; and it can be given to patients who may not be able to take other forms of prostate treatment such as brachytherapy.

Some of the possible disadvantages / side effects of this form of treatment may be difficulty in urine retention or in passing water (this is often overcome by temporary use of a catether); impotence occurs in around 50 to 70% of patients; infections of the urinary tract and bleeding; incontinence; and recto-urethral fistula.

It is hoped that you now have a fuller understanding of how high intensity focused ultrasound for the treatment of prostate cancer is carried out. As with other prostate cancer treatments it is important to have a conversation with your doctor to discuss all of your options based upon your own personal needs.