High-Intensity Focused Ultrasound
High-intensity focused ultrasound (HIFU) is a minimally invasive procedure that can be used to treat solid tumors—both benign and cancerous—in the prostate gland. For instance, HIFU may be an option for treating early-stage prostate cancer that has not spread beyond the prostate or a benign prostate tumor that is visible in imaging scans. An ideal candidate for HIFU has a small-to-medium-sized prostate gland with no major calcifications, which are areas of dense tissue that sound waves cannot penetrate.
How does HIFU treatment work?
Many people are familiar with ultrasound imaging, which uses high-frequency sound waves to create detailed pictures of internal organs. High-intensity focused ultrasound also uses high-frequency sound waves, but instead of producing medical images, the sound waves are precisely focused on abnormal tissue, such as a tumor, to destroy it. Additionally, the sound waves used for HIFU are 10,000 times more powerful than the sound waves used for producing diagnostic images.
During HIFU, the highly targeted energy will cause the temperature of the targeted tissue to rise, and the resulting heat can destroy (ablate) the abnormal cells. The concept is similar to using a magnifying glass to concentrate the energy of the sun on a small spot to create heat and burn an object.
What does a HIFU procedure involve?
To plan high-intensity focused ultrasound treatment, the healthcare team will evaluate imaging studies to determine the exact location of the abnormal tissue. During the procedure, the patient will be positioned comfortably on an examination table. Once the patient is sedated, the physician will insert a thin ultrasound probe into the patient’s rectum to capture images of the prostate and deliver the treatment, which does not involve surgical incisions or needles.
Guided by real-time imaging, the physician will use the probe to deliver a test dose of high-frequency sound waves to the center of the targeted tissue, then adjust the strength of the ultrasound beams based on the depth of the tissue. Once the optimal intensity is set, the physician will deliver bursts of ultrasound waves to the targeted tissue while the rectum is actively cooled. Each burst will last only a few seconds and treat an area of tissue that is approximately the size of a grain of rice. Throughout the procedure, the surgeon will continually monitor real-time imaging as well as the treatment parameters, such as temperature readings and calculated tissue changes, to evaluate the quality and success of the ablation.
When used for treating prostate cancer, the goal of high-intensity focused ultrasound is to treat only the area of the prostate containing the tumor while leaving the rest of the gland and the surrounding structures intact and unaffected. This approach is widely used to successfully treat other types of cancer. If multiple prostate tumors are present, the targeted tumor (index lesion) will be the largest tumor with the highest grade. Many experts believe the index lesion drives the behavior of prostate cancer, and therefore, treating it with HIFU can produce a good outcome.
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Schedule an AppointmentWhat are the potential benefits of HIFU treatment?
High-intensity focused ultrasound offers several advantages for appropriately selected patients with prostate cancer or benign prostate tumors. Because HIFU is minimally invasive and precisely targeted, it allows the physician to destroy abnormal cells while preserving healthy prostate tissue and nearby structures, such as the nerves involved in urinary and sexual function. This targeted approach may also reduce the risk of side effects commonly associated with more aggressive treatments, such as radical prostatectomy and radiation therapy, which can potentially lead to urinary incontinence, erectile dysfunction, bowel irritation, skin burns or a prolonged recovery time.
Additional benefits of HIFU include a low risk of bleeding and infection, no exposure to ionizing radiation and a shorter recovery period compared with traditional surgery. Most patients are able to return home on the same day and resume their normal activities within a short time. High-intensity focused ultrasound may also be an option for a patient who is not a candidate for surgery or who wishes to avoid more invasive treatments.
What are the possible side effects of HIFU treatment?
As with any medical procedure, high-intensity focused ultrasound carries some risk of side effects, although the complications are generally less frequent and less severe than those associated with prostate surgery and radiation therapy. Possible short-term side effects of HIFU include urinary frequency, urinary urgency, discomfort during urination, blood in the urine or semen and temporary urinary retention.
In rare cases, HIFU may cause erectile dysfunction or urinary incontinence; however, the risk is significantly lower than with more invasive treatments. Other uncommon complications include urinary tract infections (UTIs) and narrowing of the urethra. The healthcare team will discuss the patient’s individual risk profile in detail and monitor the recovery process closely.
How long does HIFU treatment last?
A high-intensity focused ultrasound procedure is usually completed in a single session lasting approximately two hours. The exact duration can vary depending on individual factors, including the size of the prostate, the location and extent of the tumor and whether focal or more extensive treatment is required.
Throughout the treatment, sedation or anesthesia will be used to keep the patient comfortable. Because HIFU is performed as an outpatient procedure, most patients can go home on the same day after a brief period of observation.
How long does it take for the prostate to heal after HIFU?
After high-intensity focused ultrasound treatment, the patient will receive individualized guidance on activity restrictions, symptom management and follow-up care. Healing typically occurs gradually over several weeks to months as the body absorbs the treated tissue. For a short period afterward, the patient may experience mild urinary symptoms, which typically improve as recovery progresses. A temporary urinary catheter may be required for a few days to assist with urination during the initial recovery phase. Through periodic imaging scans and prostate-specific antigen (PSA) tests, the healthcare team will monitor the healing process and assess the effectiveness of the treatment.
Moffitt’s approach to prostate cancer treatment
Moffitt Cancer Center is proud to offer the latest treatment options for prostate cancer, including high-intensity focused ultrasound and a robust portfolio of clinical trials, in a single location. If you were recently diagnosed with prostate cancer and would like to discuss your options with a specialist in our Urologic Oncology Program, please contact us at 1-888-663-3488 or complete our new patient registration form online to request an appointment.
References
CancerConnect – High-Intensity Focused Ultrasound Treatment for Prostate Cancer