HIFU is a novel use of ultrasound energy to destroy prostate cancer tissue. Ultrasound is simply sound waves, which in the setting of everyday diagnostic scans of the human body are harmless and are an invaluable tool in medicine. When these ultrasound waves are magnified and focused (similar to how a magnifying glass focuses the rays of the sun), they are capable of destroying tissue by heating it to high temperatures. The actual size and volume of tissue destroyed can be determined with precision with preservation of surrounding tissue. The fact that these ultrasound waves can pass through normal tissue on the way to the target cancerous tissue without damage to that normal tissue is one of the reasons why this concept has been appealing.

The patient is given a general anaesthetic and a special probe is placed in the rectum. With the aid of sophisticated computer software, the prostate dimensions and shape is carefully mapped out and the treatment settings applied. At any given moment, only a small area of prostate is treated. With the aid of the computer and precision motors within the probe, the area of prostate actually being treated is moved along sequentially and as treatment progresses, the entire prostate is eventually treated. The majority of men can be treated either as a same day admission or with an overnight stay in hospital.

There are two groups of men who are suitable for treatment with HIFU. Firstly, there are those with clinically localised prostate cancer. These are generally men who would be candidates for surgery (radical prostatectomy) or radiotherapy. Secondly, there are the men who have previously been treated with radiotherapy and the treatment has failed to eradicate the cancer in the prostate.

Once a man has undergone a full course of radiotherapy to the prostate, it is not possible to give any further radiotherapy as such treatment not only damages cancerous cells, but can also cause severe damage to normal tissue adjacent to the prostate when dosages reach a certain level.

HIFU provides a minimally invasive option for the management of localised prostate cancer. There is negligible risk of urinary incontinence. Early data indicates that erectile function is significantly less than that seen with surgery and radiotherapy. It must be emphasized that we do not have substantive data to be conclusive on the issue of erectile dysfunction, and with more prolonged follow-up it may be determined that the incidence of erectile dysfunction may be similar to both of the treatments.

Given that HIFU’s precision allows tissue surrounding the prostate to be spared of damage, the HIFU treatment can be repeated if treatment fails on the first occasion and subsequent to treatment, the option of surgery or radiotherapy often remains viable provided that the cancer has not spread to other organs.

Although HIFU has been used for the treatment of prostate cancer for several years now, until we have long term data available on the results of HIFU, we must regard it as an emerging technology and option for prostate cancer treatment rather than an established therapy. Whilst it is a minimally invasive procedure, the procedure still carries risks.

To discuss HIFU further, please contact AUA on 03 8506 3600 to make an appointment with A/Prof Mark Frydenberg.