High Intensity Focused Ultrasound (HIFU)

HIFU uses focused soundwaves, delivered through a probe placed in the rectum, to heat prostate tissue so that cancer cells die. Two main HIFU machines exist: the Ablatherm (used extensively in Europe) and the Sonablate (used mainly in Japan). Dr Kooner travelled to Japan to learn the Sonablate technique from a world leader in the field.

How treatment is described

The team scans the prostate with the probe in place, then applies focused ultrasound so the energy heats the planned region. Sometimes a prostate resection is combined so that urine flow improves afterwards.

Potential advantages discussed in the literature

  • Repeatable: treatment can be delivered again if needed.2
  • Often outpatient or overnight care.
  • May suit selected patients who are not suitable for surgery or radiotherapy.5

Concerns to weigh with your specialist

  • Relatively high rate of erectile dysfunction reported in some focal HIFU series.4
  • Long-term (10 to 15 year) outcome data are still awaited in parts of the literature.2

Experimental status in some regions

Worldwide experience is substantial, but long-term cancer control data continue to mature. In Australia, use patterns and funding rules vary. A balanced discussion within a clinical trial framework may be appropriate for some patients, depending on local ethics approval and eligibility.

This page summarises themes from the Urology NSW experimental treatments video and text. It is not a substitute for personalised medical advice.
References
  1. The clinical applications of high intensity focused ultrasound in the prostate - Rowland Illing and Alexander Chapman - International Journal of Hyperthermia, 23(2), 183-191 - https://doi.org/10.1080/02656730601173037
  2. High-intensity focused ultrasound with visually directed power adjustment for focal treatment of localized prostate cancer: systematic review and meta-analysis - Samuel J. Peretsman, Mark Emberton, Neil Fleshner, et al. - World J Urol 42, 175 (2024) - https://doi.org/10.1007/s00345-024-04840-6
  3. What is HIFU - Cancer Research UK - https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/high-intensity-focal-ultrasound-hifu
  4. Risk Factors for Severe Erectile Dysfunction after Focal Therapy with High-Intensity Focused Ultrasound for Prostate Cancer - Sunao Shoji, Satoshi Kuroda, Kohei Uemura, et al. - Biomedicines. 2022 Nov; 10(11): 2876 - doi: 10.3390/biomedicines10112876 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9687416/
  5. High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment - Mohammed Alkhorayef, Mustafa Z. Mahmoud, Khalid S. Alzimami, et al - Pol J Radiol. 2015; 80: 131-141 - doi: 10.12659/PJR.892341

Considering focal therapy?

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