High-Intensity Focused Ultrasound (HIFU) for Prostate Cancer

Overview

What is high-intensity focused ultrasound (HIFU)?

High-intensity focused ultrasound (HIFU) is a medical procedure that uses ultrasound waves to treat prostate cancer.

Ultrasound has wide use in the medical field, including providing imaging during pregnancy. In HIFU, the normally harmless ultrasound waves are produced at a higher intensity and in a highly focused form. Similar to how a magnifying glass focuses light on a target, in HIFU multiple beams of ultrasound focus on the exact tissue area within the prostate that requires treatment. The highly focused energy from the ultrasound causes the temperature of the tissue to rise, and the heat destroys (ablates) the targeted tissue area. The ultrasound beams are able to pass through layers of tissue, leaving them unharmed, until they reach their target.

What is the prostate and how common is prostate cancer?

The prostate is a reproductive gland in men. It is located in front of the rectum in the lower part of the intestine. It is about the size of a walnut and produces fluid that makes up semen.

Prostate cancer is very common in men in the United States. One in five men will be diagnosed with prostate cancer.

Who can be treated with high-intensity focused ultrasound?

High-intensity focused ultrasound (HIFU) is approved by the Food and Drug Administration (FDA) for the ablation (destruction) of prostate tissue. Who the best candidates are for HIFU is somewhat debated by urologists.

HIFU can be considered:

  • As an alternative option to monitoring (no treatment) for patients who have early stage prostate cancer.
  • As an alternative to or follow up to radiation or surgery or other failed treatment for tumors that are small and confined to an area (localized) of the prostate.

Procedure Details

What happens during the high-intensity focused ultrasound (HIFU) procedure?

During high-intensity focused ultrasound (HIFU), an ultrasound probe about the size of your index finger is inserted into your rectum while you are asleep under anesthesia. The probe is positioned up to the level of your prostate. Your prostate is located immediately behind the rectum wall.

An imaging transducer in the center of the probe scans your prostate to create a three dimensional computerized map of your entire prostate and the area to be treated. Your urologist then uses the computer to view and plan your precise treatment plan. The treatment plan is then carried out, with focused waves of ultrasound destroying the exact identified tissue. Each focused beam of energy destroys about a rice-grain size of tissue at a time. The session continues until all the diseased tissue is destroyed. After the treatment session, imaging (ultrasound or MRI) reviews the result of the treatment.

The procedure takes an average of two hours to perform depending on the size of the treatment area.

What are the advantages of high-intensity focused ultrasound (HIFU)?

Advantages of high-intensity focused ultrasound include:

  • It requires no surgical incisions into the body (non-invasive) and doesn’t use radiation.
  • It can exactly target diseased tissue, leaving non-targeted healthy tissue unharmed.
  • It is an outpatient procedure with a short recovery time. You can usually return to work or normal life in about 24 hours.
  • It reduces the risk of urinary incontinence and erectile dysfunction compared with surgery or radiation therapy.

Risks / Benefits

Is high-intensity focused ultrasound (HIFU) safe for patients?

High-intensity focused ultrasound was approved by the Food and Drug Administration (FDA) for use in about 50 countries including the United States. Outside of the US, the procedure has been used to treat prostate cancer in over 65,000 men.

What are the side effects or complications of high intensity focused ultrasound?

Even though high-intensity focused ultrasound (HIFU) is generally associated with less side effects than radiation or chemotherapy, it is not free from potential side effects and complications. These include:

  • Erectile dysfunction, ejaculation problems, sexual impotence.
  • Urinary tract infections, incontinence, frequency, burning sensation, urinary retention.
  • Rectal wall injury, rectal incontinence, burning and bleeding from the probe.
  • Prostate infection.
  • Return of prostate cancer.

Recovery and Outlook

What is the outlook for men treated with high-intensity focused ultrasound (HIFU)?

Your outlook depends upon several things, such as your general health, whether the cancer has come back, and the stage at which the cancer was treated.

Last reviewed by a Cleveland Clinic medical professional on 07/10/2020.

References

  • Sanghvi NT. . JASA 2013;134(5). Accessed 7/7/2020.High-intensity focused ultrasound treatment of prostate cancer (http://asa.scitation.org/doi/abs/10.1121/1.4830936)
  • Reddy D. Dudderidge T. Trends in Urology & Men’s Health 2020;11(3): Accessed 7/7/2020.High-intensity focused ultrasound focal therapy for prostate cancer. (https://onlinelibrary.wiley.com/doi/full/10.1002/tre.749)
  • Focused Ultrasound Foundation. Accessed 7/7/2020.Prostate Cancer. (https://www.fusfoundation.org/diseases-and-conditions/oncological/prostate-cancer)
  • Simmons MN, Berglund RK, Jones JS. Cleve Clinic J Med 2011;78(5):321-331. Accessed 7/7/2020.A practical guide to prostate cancer diagnosis and management. (https://www.ccjm.org/content/78/5/321)
  • Napoli A, Alfieri G, Scipione R, et al. Expert Rev Med Devices. 2020 Apr 10. Accessed 7/7/2020.High-intensity focused ultrasound for prostate cancer. (https://www.ncbi.nlm.nih.gov/pubmed/32275187)
  • Nahar B, Bhat A, Reis IM. J Urol. 2020 Mar 13: Accessed 7/7/2020.Prospective Evaluation of Focal High-Intensity Focused Ultrasound (HIFU) for Patients with Localized Prostate Cancer. (https://www.ncbi.nlm.nih.gov/pubmed/32167866)
  • Schmid FA, Schindele D, Mortezavi A, et al. Urol Oncol. 2020;38(4):225-230. Accessed 7/7/2020.Prospective multicenter study using high intensity focused ultrasound (HIFU) for the local treatment of prostate cancer: Safety outcomes and complications. (https://pubmed.ncbi.nlm.nih.gov/31628038/)
  • Chaussy CG. Thuroff S. J Endourol 2017 Apr;31(S1):S30-37. Accessed 7/7/2020.High-intensity Focused Ultrasound for the Treatment of Prostate Cancer: A Review. (https://www.liebertpub.com/doi/full/10.1089/end.2016.0548)

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