High Intensity Focused Ultrasound (HIFU)

[SamitivejHospital]

New treatment for prostate cancer
High Intensity Focused Ultrasound (HIFU)
Minimal Incontinence and impotence

High Intensity Focused Ultrasound (HIFU)

• What is HIFU?
• Who is HIFU for?
• Pros & Cons of HIFU
• Minimal impotence & incontinence
• How to prepare for HIFU?
• What happens during the procedure of HIFU?
• What to expect afterwards?
• Side effects of HIFU
• HIFU Complications

Disclaimer: despite more than 10 years of clinical evidence and 30,000 cases worldwide, HIFU prostate cancer treatment is still not approved as a first line treatment by the FDA.

What is HIFU?

HIFU treatment uses high intensity ultrasound energy to heat and destroy cancer cells in your prostate gland. No incision is required.

When high frequency sound waves are concentrated on body tissues, those tissues heat up and die. To use this as a prostate cancer treatment, the specialist targets the area containing the cancer. Because the prostate is deep within the pelvis, you have HIFU for prostate cancer by putting an ultrasound probe into your back passage (rectum). Doctors call this a transrectal probe. From that position, the ultrasound can direct beams accurately at the prostate.

Who is HIFU for?

You are eligible for HIFU treatment if:

• You have a low-grade cancer (cancer which has not spread outside the prostate gland). Which is often the case with newly diagnosed patients.
• You have recurrent prostate cancer after radiotherapy (known as salvage HIFU).

Pros

• No radiation.
• HIFU is less invasive than surgery to remove your prostate, which means you may have fewer complications from the treatment.
• You can normally have the procedure and go home the same day.
• There may be less chance of damaging surrounding structures and nerves after HIFU, compared with other treatments, such as surgery and cryotherapy.
• As a direct result, there is less side effects as with other treatments.

Cons

• HIFU is a relatively new treatment. This means there isn't a lot of information about how effective it is at treating prostate cancer in the long term, or how it can affect your everyday life.
• The availability of HIFU is limited. Currently, only Samitivej Hospital performs HIFU in Thailand.
• HIFU isn't an option if your cancer has spread beyond your prostate.
• One possible complication of HIFU is that it can affect your sex life. However, this is rare and only affects around two in a 100 men.

Minimal impotence & incontinence

Compared to other treatment options, HIFU has a minimal risk of urinary or sexual side effects especially when done as a focal treatment because it minimizes the risk of damaging surrounding tissues.

How to prepare for HIFU?

• Your surgeon will explain how to prepare for the procedure.
• You may have an enema the morning of your procedure. An enema is a liquid that is injected into your rectum (back passage) to empty your bowel.
• HIFU is usually done as a day-case procedure under general anaesthesia. This means you will be asleep during the procedure. Alternatively, you may be given a spinal or epidural anaesthetic. This completely blocks pain from your waist down and you will stay awake during the procedure. Your surgeon may also give you a sedative to help you to relax.
• If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.
• Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
• You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine, or instead of, wearing compression stockings.

What happens during the procedure of HIFU?

• HIFU takes up to three hours. However, the exact time your procedure will take depends on the size of your prostate and how much of it is being treated.
• Once you have been anaesthetised, your surgeon will pass a lubricated probe into your rectum. The probe will give out a beam of ultrasound. Your surgeon will focus the beam so that it heats and destroys the area of prostate tissue where there is cancer. The probe is guided by precise and sophisticated software to ensure only the desired areas of your prostate are targeted.

What to expect afterwards?

• You may need to rest until the effects of the anaesthetic have passed. If you had a spinal anaesthetic, it may take several hours before the feeling comes back into your legs. You may need pain relief to help with any discomfort as the anaesthetic wears off.
• You will have a catheter (a fine tube) to drain urine from your bladder into a bag. The catheter may pass out through either your penis or through a small cut in your abdomen (tummy). The catheter may be left in place for up to two weeks, but this can vary.
• You will usually be able to go home when you feel ready. A nurse will give you some advice about how to manage your catheter at home and may give you an appointment to return to hospital to have it removed. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your procedure.
• General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.
• Your surgeon may prescribe a course of antibiotics to help prevent you developing an infection.

Side effects of HIFU

• Blood in your urine
• Difficulty passing urine once the catheter has been removed (because of swelling in your prostate)
• Passing some of the destroyed prostate tissue and blood in your urine (which may be uncomfortable)
• Contact the hospital or your GP if you have:
  - increasing pain, or pain that you can't control with painkillers
  - a high temperature
  - increased blood in your urine
  - difficulty passing urine

HIFU Complications

• A urinary tract infection – the risk of infection is high for a few weeks. So if you’re prescribed antibiotics, it's important to complete the full course.
• Stress incontinence – the muscles around your urethra (the tube that carries urine) can become weakened. This means you may leak some urine when you cough, sneeze or make a sudden movement.
• Urge incontinence – you may feel you need to pass urine more frequently or more urgently.
• Impotence – you may not be able to get or maintain an erection after HIFU treatment.
• Infertility – your fertility may be affected.
• Damage to your rectum (back passage) – this can cause a burning feeling or bleeding from your rectum.

Find out more what our patients said about HIFU:
In two weeks, the cancer was gone
Why I went with HIFU treatment

Reference :
- http://www.cancerresearchuk.org/cancer-help/type/prostate-cancer/treatment/high-intensity-focused-ultrasound-for-prostate-cancer
- http://www.bupa.co.uk/individuals/health-information/directory/h/hifu-treatment-for-prostate-cancer

Samitivej, We Care