Focal Therapy (HIFU) - Prostate Cancer Treatment

Focal HIFU (High-intensity focused ultrasound) is a successful non-invasive treatment for prostate cancer that is offered at Beacon Hospital. This treatment uses ultrasound waves to target and destroy cancerous prostate tissue with precision, sparing nearby healthy structures. It has been used clinically for more than 20 years and can lower the risk of losing erectile function or bladder control, helping patients get back to normal life.

• Soundwave-based treatment
• Preserves urinary and sexual function
• Day procedure and rapid recovery

High intensity focused ultrasound (HIFU) uses sound waves, produced from high frequency vibrations originating from a transducer, to create localised cell kill. Temperatures of up to 80-100˚C are reached in the tissue at the focus point, resulting in cell death through necrosis and cavitation. Since its development in the 1940s it has been used to treat benign and malignant lesions within a number of solid organs, including uterus, brain, kidney and liver, with the addition of prostate from the 1990s.

HIFU is considered an alternative primary treatment option to traditional radical therapy (radical prostatectomy, external beam radiotherapy, seed brachytherapy). The advantages of HIFU as a prostate cancer treatment is that it is minimally invasive, delivered in the day-case setting, only requires one hospital visit of treatment and is repeatable if needed.

Furthermore, additional prostate treatment is not precluded if cancer recurrence occurs following HIFU, such as cryotherapy, radiotherapy or surgery, albeit with a higher risk profile than in the treatment naïve gland. HIFU treatment is limited to prostates of a moderate size that can be covered by the focal length for treatment, as the anterior aspect of the gland cannot be reached in large glands.

In terms of functional outcomes, 1% of men have some urine leakage after HIFU (which compares favourably with radical treatment). Of men who have good erections without the need for tablets before HIFU, 2 in 3 men will continue to have these after treatment and 1 in 3 men will need to have tablets to support the erections. The majority of men will notice a reduction in the volume of ejaculate, and fertility can be reduced.

A careful assessment of the prostate using high quality MRI and biopsies is needed to assess suitability for HIFU. Men with prostate cancer deemed intermediate risk and localised to the prostate with no spread of their disease (metastases) are potentially eligible for focal therapy with HIFU (stage T1-3).  Patients who have had a recurrence after surgery (radical prostatectomy) or radiotherapy are eligible.

The exact position of the tumour is critical to the assessment. Some men have tumours that are suited to focal therapy but would be better suited to a needle based transperineal approach, rather than the transrectal approach of HIFU.

Some patients who are unsuitable for HIFU may be eligible to have cryotherapy or another needle based ablative technique such as Nanoknife electroporation, such as those with:

• Large prostates greater than 40cc
• Lesion to be treated is in anterior aspect of the gland
• High level of prostatic calcification
• Previous Brachytherapy
• Unable to have a general anaesthetic
• Previous rectal surgery or rectal disease such as colitis

Mr Mohammud Shakeel Inder is an expert in delivery of Focal therapy for Prostate Cancer. For more information about Focal Therapy please contact [email protected].