What is HIFU for prostate cancer?

Dr. Marc B. Garnick, MD
Hematologist & Oncologist

High-intensity focused ultrasound (HIFU) uses sound waves produced by a rectal probe to treat prostate cancer. Proponents of HIFU tout the fact that it is even less invasive than cryotherapy (which kills cancer cells by freezing them). Physicians still use the rectal ultrasound probe, but they don't need to insert needles through the perineum and into the prostate. Like cryotherapy, HIFU can also be repeated if necessary.

Several scientific papers have concluded that HIFU appears effective for the treatment of prostate cancer. For example, Japanese researchers reported in 2006 that 87 percent of 63 HIFU patients enrolled in a clinical trial had negative biopsies six months after the procedure. After a median period of 22 months, 75 percent were biochemically disease-free. And a French study of 227 patients noted that 86 percent of them had negative prostate biopsy specimens three months after HIFU. Although patients were followed only for an average of 27 months, researchers projected that 66 percent of them would be free of biochemical or pathologic recurrence after five years.

Many of the patients participating in these studies reported urinary problems in the first few months after HIFU treatment. Some had difficulty urinating that was caused by swelling or by bits of tissue obstructing urine flow. Others suffered from incontinence, developed infections, or experienced changes in urinary frequency or urgency. In most cases, these side effects were only temporary. Reported impotence rates ranged from 20 percent to nearly 50 percent, though these numbers should be taken with a grain of salt because validated questionnaires of erectile dysfunction were not used consistently.

Note that this procedure has not been approved by the FDA for use in the United States, and the length of time men who received it have been followed after the procedure is very short compared to other modalities.

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