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High intensity focal ultrasound (HIFU)

HIFU uses high frequency sound waves targeted at the area of cancer cells. The waves create heat that destroys the cancer cells. You might have HIFU for prostate cancer as part of a clinical trial. 

Who can have HIFU treatment?

Your doctor might recommend HIFU for:

  • newly diagnosed prostate cancer
  • cancer that’s come back in your prostate

You can’t have HIFU if your cancer has spread to other parts of your body (advanced cancer).

Treatment can target:

  • the whole prostate (whole prostate HIFU)
  • specific areas of prostate cancer (focal HIFU)

You usually can leave on the same day that you have HIFU. 

Before your treatment

You might have an MRI scan and samples of tissue removed from your prostate (biopsy) before treatment. Doctors use this to plan your treatment.

On the day of treatment

You have an enema to empty your bowels. An enema is a liquid filled pouch with a nozzle that you put into your back passage (anus). 

You stop eating and drinking for 6 hours before the procedure.

You have a small tube (cannula) put into a vein in the back of your hand. You usually have a general anaesthetic .

Having your treatment

Your surgeon puts a thin tube into your bladder through the hole at the end of your penis. The tube drains your urine. It is called a urinary catheter.

Your surgeon puts an ultrasound probe into your back passage (rectum). This probe gives out high intensity ultrasound that can destroy the cancer cells in your prostate. The high intensity ultrasound travels through the back passage to the prostate. 

The probe also works as an ultrasound and makes a picture on a screen. This shows your surgeon where they need to target. They move the HIFU probe around to treat all of the cancer cells.

Whole prostate HIFU treatment takes about 3 hours. HIFU to a smaller area takes 1 to 2 hours (focal). 

After your treatment

When you have recovered from the anaesthetic you can go home, usually on the same day.

You might have a catheter for up to a week to drain urine. If you go home with a catheter your nurse will teach you how to care for it. They will arrange for it to be removed.

Diagram of a catheter.jpg

Side effects

You might have pain in the area between your testicles and back passage (rectum). You can take painkillers to help.

You might have some blood or small pieces of prostate tissue in your urine. This can last for a few weeks.  

At first you might have difficulty having or keeping an erection. For many men this goes back to normal. Treatments can help with erection problems.

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine or feeling cold or shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 38°C. Severe infections can be life threatening. 

You might have problems passing urine if the prostate swells after HIFU. The swelling can block the urethra (the tube carrying urine from your bladder to outside your body). This might happen straight after removing your catheter. It is called urinary retention.

Tell your doctor straight away if you can't pass urine at all. Or go to your local accident and emergency department.

You might need to have a catheter for a short time to drain the urine.

You doctor may suggest that you learn how to put in a catheter to drain your urine at home. This is called self catheterisation. You take the catheter out when the bladder is empty. Your nurse will teach you how to do this.

Infection can start in the small tubes that carry sperm from the testicles. You might have:
  • swelling in one or both of your testicles
  • pain or tenderness in one or both of your testicles

Tell your doctor or nurse if you have swelling or pain. You might need antibiotic tablets.

Long term side effects

If you think that you might want to have children in the future you can store some sperm before treatment to use in fertility treatment. Tell your doctor if you want to store sperm.

Many men go back to having normal erections after HIFU treatment.

HIFU doesn’t usually affect your ability to have an orgasm. Orgasms may feel different but usually don’t lower your enjoyment of sex. But you may have less semen or no semen at all.

Your semen might go backwards into the bladder instead of out through your penis. This is called retrograde ejaculation. It isn’t harmful. The semen then passes out of your bladder in your urine.

You may have:
  • leakage of urine when you sneeze, cough, or exercise (stress incontinence)
  • slight, continuous leakage of urine (this is more likely if you have also had external beam radiotherapy)
  • a need to pass urine more often (frequency)
  • a sudden urge to pass urine (urgency)
Very rarely, HIFU can make a hole between your back passage (rectum) and your urethra. This is called a recto urethral fistula. Symptoms can include:
  • passing urine from your back passage (rectum)
  • pain in your pelvis or back passage (rectum)
  • poo in your urine
  • air bubbles in your urine
  • infection

Tell your doctor or nurse straight away if you have any of these symptoms. A small operation repairs the hole.

HIFU and clinical trials

HIFU is a new treatment. It is not available in every hospital.

Your doctor might offer you HIFU treatment as part of a clinical trial.

Research has shown that HIFU for prostate cancer is safe. But we still need more research about whether it is as good as other treatments and about its possible side effects.

Last reviewed: 
24 Jun 2019
  • Comparative morbidity of ablative energy-based salvage treatments for radio-recurrent prostate cancer
    A Williams and others
    Canadian Urological AssociationJjournal, 2015. Volume 9, Pages 325-329 

  • Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review
    M Peters and others
    World Journal of Urology ,2016

  • A prospective clinical trial of HIFU hemiablation for clinically localized prostate cancer
    R Van Velthoven and others
    Prostate cancer and protastatic diseases, 2016. Volume 19, Pages 79-83

  • Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study
    E Baco and others
    British Journal of Urology, 2014. Volume 114, Pages 532-540

  • Prostate cancer: diagnosis and management
    National Institute for Health and Care Excellence, 2019. 

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