HIFU for Prostate Cancer: High-Intensity Focused Ultrasound – Complete Guide

What is HIFU for prostate cancer?

High-Intensity Focused Ultrasound (HIFU) is a minimally invasive, non-surgical treatment that uses focused ultrasound waves to heat and destroy prostate cancer cells. It is the most commonly performed focal therapy for prostate cancer worldwide.

HIFU can be used as primary treatment for localized prostate cancer or as salvage treatment for cancer that recurs after radiation therapy. It is FDA-approved for ablation of prostate tissue.

How does HIFU work?

HIFU works by focusing high-intensity ultrasound waves on a specific target within the prostate, similar to a magnifying glass focusing sunlight:

• A transrectal ultrasound probe emits focused ultrasound waves
• The waves are focused on a small target (2-3 mm) within the prostate
• At the focal point, temperatures reach 80-100°C (176-212°F)
• This causes coagulative necrosis (cell death) of the targeted tissue
• Real-time ultrasound imaging guides treatment and monitors tissue changes
• The surrounding tissues (urethra, rectum, nerves) are spared

Whole-gland vs. focal HIFU

HIFU can be performed as whole-gland or focal treatment:

• Whole-gland HIFU: Entire prostate is treated. Higher side effect rates (ED, incontinence). Used for intermediate-risk cancer involving both lobes.
• Focal HIFU (hemiablation): Only the cancerous part of the prostate is treated (one lobe or a specific lesion). Lower side effect rates. Used for unilateral, low to intermediate-risk cancer.
• Focal HIFU (lesion ablation): Treats only the MRI-visible lesion (index lesion). Very low side effects. Used for small, low-risk cancers.

Who is a candidate for HIFU?

Primary HIFU (for untreated cancer):

• Low-risk or favorable intermediate-risk prostate cancer (Gleason 6 or 3+4=7)
• Unilateral disease (one side of the prostate) – for focal HIFU
• MRI-visible lesion (PI-RADS 4-5)
• Prostate size <60 mL (preferred)
• No evidence of extracapsular extension or seminal vesicle invasion
• Patient preference to avoid surgery or radiation

Salvage HIFU (for cancer recurring after radiation):

• Biopsy-proven local recurrence after external beam radiation or brachytherapy
• No evidence of metastatic disease
• Life expectancy >10 years

The HIFU procedure – what to expect

Before the procedure:

• Stop blood thinners as directed (5-7 days before)
• Bowel preparation (enema)
• Antibiotics to prevent infection

Day of procedure:

• Anaesthesia: Spinal or general anaesthesia
• Duration: 1-3 hours (depending on prostate size)
• Hospital stay: Outpatient or 23-hour stay

Step-by-step:

1. You are positioned on your back or side
2. A transrectal ultrasound probe with a HIFU transducer is inserted
3. The prostate is mapped in 3D
4. The surgeon plans the treatment area (targeting cancer)
5. Focused ultrasound pulses are delivered (each pulse lasts 3-5 seconds)
6. Real-time imaging confirms tissue changes (hyperechoic bubbles)
7. The probe is removed
8. A urinary catheter is placed (temporary)

Recovery and side effects – ED, incontinence, retention

Immediate side effects (first 1-2 weeks):

• Catheter: 3-7 days (focal) or 7-10 days (whole-gland)
• Hematuria (blood in urine): Common – resolves in days
• Dysuria (painful urination): Common – treat with urinary analgesics
• Urinary retention: 5-10% (catheter reinsertion may be needed)
• Swelling of the scrotum/perineum: Temporary

Long-term side effects (focal HIFU):

• Erectile dysfunction (ED): 10-20% at 2 years
• Urinary incontinence: <5% need pads
• Urethral stricture: 2-5% (narrowing of the urethra)
• Rectal injury/fistula: <1% (rare)

Long-term side effects (whole-gland HIFU):

• Erectile dysfunction: 30-60% at 2 years
• Urinary incontinence: 5-15% need pads

Success rates – biochemical recurrence-free survival

Success rates vary by risk group and treatment extent:

Primary focal HIFU (low to intermediate-risk):

• 5-year biochemical recurrence-free survival: 75-85%
• In-field recurrence (treated area): 10-15%
• Out-of-field recurrence (untreated area): 15-20%
• Need for repeat treatment: 20-30% within 5 years

Primary whole-gland HIFU:

• Low-risk (Gleason 6): 5-year biochemical recurrence-free survival: 80-90%
• Intermediate-risk (Gleason 7): 5-year biochemical recurrence-free survival: 70-80%
• High-risk (Gleason 8-10): 5-year biochemical recurrence-free survival: 50-70%

Salvage HIFU (after radiation failure):

• 5-year biochemical recurrence-free survival: 40-60%
• Higher complication rates (incontinence 10-20%, fistula 1-5%)

HIFU vs. cryotherapy vs. surgery vs. radiation

Feature	HIFU (Focal)	Cryotherapy (Focal)	Surgery	Radiation
Erectile dysfunction	10-20%	10-20%	20-50%	20-40%
Urinary incontinence	<5%	<5%	5-10%	<5%
Bowel side effects	<1%	<1%	<1%	10-20%
Dry ejaculation	No	No (focal)	Yes	No
Hospital stay	Outpatient	Outpatient	1-2 days	None
Recovery time	1-2 weeks	1-2 weeks	2-4 weeks	During treatment
Catheter	3-7 days	3-7 days	7-10 days	None

Interactive FAQ – HIFU for prostate cancer

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Disclaimer: This information is for educational purposes. HIFU is a treatment option for select prostate cancer patients. Discuss with a urologist at Vivekananda Hospital to determine if you are a candidate.