HIFU (High-Intensity Focused Ultrasound) for prostate cancer

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HIFU (high-intensity focused ultrasound) therapy is a precise prostate cancer treatment that has been performed worldwide for decades. Hundreds of peer-reviewed medical publications demonstrate the effectiveness and low side-effect profile of HIFU therapy.

I became interested in HIFU in 2006 after extensive experience with prostate cancer surgery and radiation therapy. The possibility of precisely targeting prostate cancer without damaging the urethral sphincter mechanism or disturbing the neurovascular bundles essential for erections was an exciting and promising advancement.

Now, after nearly 20 years of experience and thousands of treated men, I continue to advocate for and perform HIFU procedures in appropriately selected candidates. If I were a good candidate for HIFU, it is the treatment I would choose for myself.

The technology has advanced significantly and now offers greater precision and safety, including the use of MRI fusion to develop treatment plans based on the exact location of the cancer.

I utilize both the Sonablate and FocalOne systems based on specific clinical criteria.

I can humbly say that very few physicians worldwide have as much experience with HIFU.

Ideal candidates for HIFU include:

1. Gleason score 6 or 7 (Gleason 8 can also be treated effectively, but additional imaging is required prior to treatment)
2. PSA less than 15
3. Prostate size less than 40 cc
4. Minimal prostate calcification as determined by ultrasound
5. Normal rectal anatomy
6. Normal bladder function
7. A patient motivated to treat cancer while minimizing side effects and wishing to avoid radical surgery or radiation therapy

HIFU uses precisely focused ultrasound energy to rapidly heat intracellular water within cancer cells, causing cellular destruction. The energy is delivered directly to the cancerous tissue and includes a margin of surrounding normal tissue to optimize treatment effectiveness.

HIFU can be applied in several ways:

1. Focal therapy – Targets a specific cancer lesion confirmed by MRI and biopsy, including a margin around the tumor
2. Hemiablation – Treats one side of the prostate where cancer is localized
3. Whole gland therapy – Used when cancer is present in multiple areas on both sides of the prostate
4. Salvage therapy – For cancer recurrence after radiation therapy
5. Retreatment – Used to treat new cancer areas identified after initial therapy

All HIFU patients require periodic MRI imaging, typically for one to two years following treatment, to monitor for recurrence or new abnormalities.

The overall 10-year cancer-free rate with HIFU is approximately 90%. Depending on the initial cancer characteristics or in cases of recurrence, outcomes may vary.

HIFU is performed on an outpatient basis under general anesthesia. Most procedures take 1–2 hours. Side effects are typically mild and short-lived. Patients are prescribed an antibiotic while the catheter is in place, along with a bladder antispasmodic and either ibuprofen or acetaminophen.

Patients may travel or drive the day after treatment and can resume normal activities once the catheter is removed.

A urinary catheter is placed at the time of treatment and typically remains in place for 5–7 days to allow post-treatment swelling to subside. Catheter removal is performed in the office or, in some cases, by the patient. We provide full support to help patients manage the post-operative catheter period.

While expertise in HIFU therapy in the United States continues to grow, the best outcomes are consistently achieved by physicians with the most experience.