HIFU also called high-intensity focused ultrasound is a minimally invasive radiation free procedure that uses high frequency ultrasound and heat to destroy cancer cells in the prostate through the probe inserted into the rectum without harming the prostate gland and surrounding nerves. This procedure can be used to manage benign prostatic hyperplasia and recurrent prostate cancer. HIFU device can kill single cancerous tumor or large tumor and may not be suitable for metastasized cancer cells. HIFU treatment is most suitable option for the patients:
• Who have low grade cancer
• Recurrent prostate cancer after radiotherapy, hormonal ablation, radical prostatectomy
• Cannot undergo prostatectomy due to age or other health issues
• Newly diagnosed prostate cancer
Patient having advance prostate cancer (metastatic) are not recommended for this treatment. HIFU is safer and better option than prostatectomy. Prostatectomy is a surgical procedure which involves removing of the whole prostate gland and it is performed in Operation Theater while HIFU is outpatient procedure that is limited to killing of the cancerous tissues in the prostate gland.
Some of the advantages of HIFU treatment are as follows:
• less recovery time
• can go back home same day
• no incisions or cuts
• less invasive
Before the treatment, patient might have a MRI scan and prostate biopsy to plan the treatment. If the patient has a large prostate, doctor may suggest some other treatment like hormone therapy (given for 2-3 months before HIFU treatment to make the prostate smaller) or transurethral resection of the prostate (TURP – to remove prostate tissue and improve urine flow) making the prostate cancer easily operable before performing the HIFU. There are two types of HIFU treatments.
1. Focal HIFU – is suitable option for the patients having cancer in only one and smaller area of the prostate without any damaged done to the nearby healthy tissues as compared to whole –prostrate HIFU. This procedure generally takes one to two hours. Focal HIFU also involves some risk as some areas of cancer that requires treatment might get missed out due to the limited area coverage instead of whole prostate. This can lead to further treatments.
2. Whole –prostate HIFU -treats the entire prostate gland where the treatment is required for more than one area of the prostate. This procedure can take up to 3 hours.
During the HIFU treatment, patient may require keeping fast from 8-10 hours before the procedure and will be given enema (liquid put in to back passage) to empty the bowels. General anesthesia will be given to put the patient to sleep during the treatment. Surgeon will then put a thin catheter inside the bladder through the small hole of the penis or the wall of your abdomen to drain urine out. This tube is called urinary catheter. Ultrasound probe will be inserted inside the rectum which delivers a high intensity beam of ultrasound energy that travels through the wall of back passage into the prostate. Doctor will move the probe around to kill all of the cancer tissues/cells. This probe is surrounded by a cooling balloon and doesn’t harm the back passage or rectum.
After the treatment, patient can go home same day after recovering from the anesthesia effects and feels fit to go. There can be some pain in the testicle area and the back passage for which doctor will suggest pain relieving medicines, laxatives to help in emptying the bowels easily and antibiotics to prevent infection. Patient may have to use catheter for some weeks with the proper instructions given by the doctor to drain out the urine from bladder as HIFU causes the prostrate to swell.
Although this is less invasive surgery but it still has some side –effects such as:
• Discomfort and pain while urinating
• Frequent urination or minimal urination leakage
• Urinary infection (fever, cloudy or dark urine, burning )
• Urethral stenosis (blockage of the urethra)
• Erectile dysfunction
• Scarring of the prostate
• Testicle infection
• A hole between the rectum (back passage) and urethra.
• Less effective at controlling cancer cells