What is HIFU for prostate cancer?

HIFU or High intensity-focused ultrasound therapy for prostate cancer is a selective therapy that uses ultrasound technology to destroy cancer cells. A rectal probe is inserted to generate ultrasound images which are combined with earlier read MRI images, resulting in three-dimensional treatment areas. The execution is computer-assisted through the use of the HIFU device. The high-energy sound waves engender high temperatures which is between 85 and 90°C with the help of a transducer that amplifies those sound waves, just like the amplification of sunlight through a magnifying glass, leading to the destruction of the cancer cells to the millimeter. In focal therapy, the sound waves burn just the tumor foci without damaging the healthy tissue.

Another feature that High intensity-focused ultrasound therapy for prostate cancer has is an external motion detector that monitors the distance to the rectal wall and constantly cools the rectum wall which assures that there is no damage to the rectum.

What the patient should know concerning the procedure is that the treatment is inpatient and is conducted under anesthesia. A catheter is placed after the procedure for 4 to 8 days and the hospital stay lasts 2 days.

When do you need HIFU therapy (Indications)?

It is important to know that targeted focal therapy for prostate cancer is not suitable for all patients, the overall state of health and other certain criteria should be judiciously examined.

The doctor can recommend HIFU if:

• The patient is diagnosed with an initial stage of prostate cancer
• The cancer is localized i.e. confined to the prostate gland only
• There is recurrent localized prostate cancer
• Prostate cancer is limited to one or very few foci in the prostate;
• The Gleason score which is an estimator of the level and grade of tissue change should not be greater than 3+3 or 3+4
• The PSA value which is an indicator of the existence of prostate cancer is under 15 ng/ml
• The operation is not an option due to health problems or a personal choice;

More than 80% of patients have a multifocal tumor necessitating treatment of the whole prostate therefore; HIFU is not possible as well as if prostate cancer has expanded to other parts of the body (metastasis) the treatment is not performed.

How is HIFU for prostate cancer performed at the clinic?

Before the treatment, different parameters are first checked by:

• An MRI scan
• A biopsy (samples of tissue)

On the day of the treatment, the patient is asked to:

• Clear his bowels with an enema
• Halt eating and drinking 6 hours before the procedure;
• Have a cannula (little tube) inserted into a vein in the back of his hand, and have a general anaesthesia

During the treatment

• The surgeon inserts a urinary catheter which is a thin tube that is put in the patient’s bladder through the urethra to drain urine;
• An ultrasound probe is then inserted in the rectum which is responsible for destroying the prostate cancer cells through the high-intensity ultrasound.
• The probe also generates images of the prostate that can be visualized on the screen. Thanks to the double function of the probe, the doctor can localize the target and move the HIFU probe to treat every cancer cell

The HIFU treatment can target the entire prostate which can take about 3 hours. However, localized prostate cancer or small areas can take 1 to 2 hours. 

After the treatment the patient can go home the moment, he recovers from anesthesia which is usually on the same day of the treatment. He can also have a urinary catheter for 4 to 8 days to drain urine and the nurse will help teach the patient how to care for it.

The patient is also recommended to undergo the following follow-up tests afterward:

• PSA assessment once every quarter of a year
• MRI control after 6 to 12 months
• Biopsy if recurrence is expected

Advantages of HIFU therapy for prostate cancer

The HIFU therapy for prostate cancer is specifically optimistic if the tumor is small and has a low Gleason value. In addition, the intervention and its risk are proportional to the size of the tumor; the smaller the tumor area the smaller the intervention, and the lower the risk of damaging the nerve bundles and sphincters which is an advantageous point of the HIFU for an early stage of prostate cancer.

Initial studies of 227 patients showed that HIFU therapy for localized prostate cancer presented great control of local disease with little morbidity. These results are similar to what can be obtained with other salvage strategies such as radical prostatectomy and radiation therapy. Nevertheless, HIFU demonstrates low postoperative morbidity with fewer side effects.

Side effects of HIFU for prostate cancer

Compared to other prostate cancer treatments, high-intensity-focused ultrasound has fewer side effects and the ones that can be observed are:

• Pain between testicles and rectum (This can be controlled with painkillers)
• Blood in urine
• Urine infection
• Infection in the testicles

Long-term side effects (Rare)

• Infertility
• Erection problems
• Urine problems

Cost of HIFU for prostate cancer in Germany

The cost for treatment of the initial stage of prostate cancer with HIFU therapy varies depending upon the hospital and the treating doctor.
The usual cost of HIFU for prostate cancer in Germany ranges from a minimum price of 14.000 Euros to a maximum price of 25.000 Euros. This amount covers the cost of the initial clinical and laboratory examination, the HIFU therapy itself, the follow-up examinations, the hospital stay, and the elaboration of recommendations for future treatment.