MENUFrequently Asked Questions About HIFU
What happens during a HIFU procedure?
Preparation
Prior to undergoing the HIFU procedure a prostate MRI and targeted biopsy should be completed. This enables the surgeon to use MRI guidance throughout the procedure to ensure that the entire cancer is treated while avoiding injury to critical anatomic structures. A comprehensive prostate ultrasound will be done to map the size and characteristics of your prostate. Patients with prostate larger than 30-40g on imaging or prostate calcifications that can affect the transmission of ultrasound waves may require an additional procedure before treatment. In those cases, a transurethral resection of the prostate (TURP) is performed to decrease the size of the prostate and remove calcifications. The surgeon will work with your primary care doctor to ensure that you are able to safely undergo general anesthesia which will include a preoperative evaluation and examination, review of medications and blood tests. Before the treatment, an enema will be administered to ensure the rectum is clean and free of stool.
HIFU Procedure
The procedure is performed under general anesthesia. As the delivery of energy is extremely precise, it is essential that you are completely asleep so that no unexpected movements happen during the treatment. After being placed under general anesthesia the ultrasound transducer is placed in the rectum. Ultrasound images of the prostate are acquired and can be fused with MRI imaging performed prior. The surgeon will identify the area of concern on the MRI and ultrasound creating a treatment plan of tissue that requires ablation. The HIFU device will then ablate the area by creating overlapping focal volumes until the entire mapped treatment zone has been destroyed. Depending on the amount of tissue needing to be treated, the procedure takes on average 2-4 hours. A urinary catheter is placed during the procedure left in for 3-7 days following a focal treatment.
Recovery
After the procedure is completed, patients remain in the recovery room for 1-2 hours and are discharged home the same day. Most men will return to their normal daily activities 24-48 hours following the procedure. The catheter is removed in the office at the first postoperative visit.
What are the side effects of HIFU?
A major reason that HIFU has generated so much interest as a focal therapy treatment is the favorable side effect profile when compared to radiation or radical prostatectomy. A focal ablation can avoid the injury to the nerves responsible for erectile function or the bladder/urethra which can result in urinary incontinence.
The most common side effects include rectal irritation, urinary frequency and urgency, urinary retention and urinary tract infection. These symptoms are usually self-limited, resolve within a few days of treatment and can be managed effectively with medications as required. There is little to no pain that is experienced after the procedure.
Though focal therapy yields improvements in urinary continence and erectile function compared to existing options they still do occur and are not uncommon. The degree to which urinary continence or erectile function are affected are primarily due to the amount of prostate treated and the location of the treatment area. A recent study from the United Kingdom demonstrated that 92% of men maintained urinary continence and 77% with normal erectile function prior to treatment maintained potency one year following a focal ablation.
Rare side effects of treatment include urethral strictures, rectourethral fistulas and infections of the pubic bone. Though extremely uncommon the management of these side effects may require a second procedure.
How well does HIFU treat cancer?
Given that HIFU is a new procedure in the U.S., long term cancer outcomes are not yet available. The measure of success with focal therapy is determined by follow-up MRI imaging and prostate biopsies following treatment. After treatment only 8-20% of patients will have clinically significant prostate cancer in the treated area. As would be expected, this is higher than that of whole gland radiation of radical prostatectomy. However, persistent cancer can be retreated with HIFU, alternative focal therapy modalities or undergo whole gland treatment if required.
What happens after treatment?
After treatment, patients are followed closely by their Urologist in a regimen akin to active surveillance. This consists of a PSA blood test every 3-6 months, prostate exam, and prostate imaging/biopsy every 1-3 years. If prostate cancer is present within or outside the treated area, retreatment can be offered as indicated. Patients are monitored for the side effects noted above, with interventions as required to help manage these.
Is HIFU covered by insurance?
Currently, HIFU is not covered treatment option. The University of Michigan Rogel Cancer Center does offer financial services and resources for patients in financial need.