HIFU – High Intensity Focused Ultrasound
HIFU is a new technology that uses ultrasound energy rather than radiation to ablate prostate cancer cells. The energy is focused by a specific transducer which integrates the ultrasound imaging and therapy to allow precise destruction of a specified volume of prostate tissue with preservation of the adjacent structures.
Ultrasound has the unique advantage of being able to bypass normal surrounding tissues including nerve bundles and hence has a minimal risk to your erection and control of urine.
Assoc. Prof. Appu has completed HIFU training with Professor Uchida, who is amongst the pioneers of this technique. He also undertook a year of research in transurethral HIFU using MRI guidance at the University of Toronto and has published internationally in this area.
The procedure is performed as a day case under general anaesthesia. A sonablate probe is inserted through the back passage and the prostate shape and volume is carefully reconstructed using a complex computer program. The treatment area is approximately the area of a grain of rice and with careful cooling of the rectum and nerve bundles, allows gradual and efficient treatment of the entire prostate.
The majority of patients are discharged as a same day admission.
This treatment is reserved for two main sub groups.
The conventional use of HIFU is for salvage treatment for patients who have failed previous radiation or surgical treatment of their prostate cancer. HIFU carries minimal morbidity (side effects) and is an option for patients who have had local recurrence.
The evolving rule of HIFU is in young fit healthy patients with low risk prostate cancer. The majority of these patients are men who may have initially undertaken active surveillance or may have considered alternative treatments for low risk prostate cancer but are keen to avoid side effects to their potency or control of urine.
HIFU offers an excellent chance of preserving continence and erections with minimal morbidity, however HIFU is thought to be less powerful as a treatment and carries a high risk of recurrence on re-biopsies when compared to surgical removal of the prostate or conventional radiotherapy. Given the minimal damage to the tissues around the prostate HIFU treatment can be repeated and remains a viable option.
HIFU is an emerging technology and at this stage cannot be considered equivalent to the established treatment options of surgery and radiation. All patients who are interested in HIFU need to be adequately counselled regarding the need for close follow up and biopsies including the need for longer term data regarding its viability.
It is very important to select out patients carefully for the treatment of HIFU to achieve the best chance of cancer cure success as well as the obvious benefits of maintaining continence and potency.