High-intensity focused ultrasound (HIFU) is a treatment that uses focused ultrasound energy to heat and destroy prostate tissue. It may be considered for some people with localised prostate cancer, particularly as a focal treatment that targets the area of the prostate containing clinically significant cancer rather than treating the whole gland.
HIFU is not one of the standard treatments routinely offered to everyone with localised prostate cancer. Whether it is appropriate depends on the location and extent of the cancer, MRI and biopsy findings, previous treatment, general health and the expertise available at the treating centre.
Read NHS information about prostate cancer treatment.
How does focal HIFU work?
For focal HIFU, imaging and biopsy information are used to identify the part of the prostate that needs treatment. During the procedure, an ultrasound probe is placed in the rectum. High-intensity ultrasound energy is focused on the target area, heating and destroying the selected prostate tissue.
The procedure is normally carried out under general or spinal anaesthesia. A urinary catheter is commonly needed for a period after treatment.
What does NICE say about HIFU?
NICE guidance says that evidence on the safety of focal HIFU for localised prostate cancer is adequate, but evidence about how well it works in the longer term is limited. NICE therefore says the procedure should be used with special arrangements for clinical governance, informed consent, and audit or research.
This is different from saying that HIFU is either prohibited or a routine replacement for established treatments. Anyone considering HIFU should be given clear information about the uncertainties and the established alternatives.
Read NICE guidance on focal HIFU for localised prostate cancer.
Who might be considered for HIFU?
HIFU may be discussed for selected people whose cancer is confined to the prostate and can be accurately identified and targeted. It is not suitable for every pattern or risk group of prostate cancer.
Your specialist team should discuss HIFU alongside established options that may be appropriate for you, such as active surveillance, surgery, external beam radiotherapy or brachytherapy.
Possible benefits and uncertainties
Because focal HIFU aims to treat only part of the prostate, one potential advantage is reducing damage to surrounding healthy tissue. This may reduce some urinary or sexual side effects compared with whole-gland treatments for appropriately selected patients.
However, prostate cancer can occur in more than one area of the gland, and longer-term evidence comparing focal HIFU with established treatments remains limited. Further treatment may be required if cancer remains, returns or develops elsewhere in the prostate.
Possible side effects
Possible effects can include:
- urinary discomfort, urgency or difficulty passing urine
- urinary infection
- erectile dysfunction
- urine leakage
- narrowing of the urethra
- the need for a catheter after treatment
Less common but potentially serious complications can also occur. Your specialist should explain the risks that apply to the particular HIFU technique being proposed.
Follow-up after HIFU
Follow-up is important because focal treatment leaves untreated prostate tissue in place. Monitoring may include PSA blood tests, MRI scans and, in some circumstances, further biopsy. The precise follow-up programme should be explained by your treating team.
Questions to ask your specialist
- Why do you think my cancer is suitable for HIFU?
- Would you treat part of my prostate or the whole gland?
- What are the established alternatives in my case?
- What do we know about the long-term results of HIFU for someone with my cancer?
- What side effects are most likely?
- What follow-up tests will I need?
- What treatments would still be available if the cancer returns?
This information provides a general introduction to HIFU for prostate cancer and does not replace advice from your urologist, oncologist or specialist cancer team.