Have you been offered HIFU for your localised prostate cancer?
Low- and intermediate-risk prostate cancers have several treatment options. Standard radical prostatectomy, radiation therapy, and hormone therapy are common choices among prostate cancer patients.
High-intensity focused ultrasound, or HIFU, is a focal therapy. The treatment is through an ultrasound probe that generates high temperatures through focused ultrasound waves that kill prostate cancer cells. The cooling balloon protects the surrounding healthy tissue, limiting the heat to the treated area.
The treatment is still experimental by the European Association of Urology (EAU) guidelines. One clinical trial after another have shown benefits and it is recognised treatment by the National Institute of Health and Care Excellence (NICE).
More reliable long-term data needs to be available for prostate cancer that has breached the prostate capsule. More well-designed studies are needed to see how patients do over several years.
What are the advantages of ultrasound therapy for prostate cancer?
The appeal of this focal treatment option is that it carries few side effects—a slight chance of erectile dysfunction and less risk of urinary problems compared to surgery or radiation therapy.
HIFU treatment is a day-case procedure with a relatively quick return to life in a few weeks. Further treatment if prostate cancer comes back is possible.
Is HIFU the best treatment for prostate cancer?
One size does not fit all. HIFU treatment is not an exception.
Various treatment options must be discussed with your NHS consultant, private urologist, nurse specialist, or oncologist. Treatment has to be tailored according to your medical fitness and prostate cancer.
Ultrasound therapy for prostate cancer is for localized or advanced prostate cancer patients.
Does focal therapy work?
After focal therapy, 75% of men will not need further treatment.
Around 7% of men will require radical treatment (radical prostatectomy or radiation therapy).
Is HIFU available in the UK?
This focal therapy is available in the United Kingdom, but in specific centers in the UK or as part of a clinical trial.
Does health insurance cover HIFU?
All the major healthcare insurers in the UK cover focal HIFU therapy.
The relevant CCSD Code for HIFU is M6770.
Is HIFU given only to the prostate gland's focal area(s)?
There are two options, depending on your prostate cancer stage and the size of your prostate:
· whole prostate gland HIFU
· focal HIFU (specific treatment area or areas only)
Who is eligible for HIFU treatment?
The criteria to be eligible are:
· localised prostate cancer (contained in the prostate)
· locally advanced prostate cancer (prostate cancer has just breached the prostate gland capsule. There is a high risk of cancer coming back; consider your options carefully.)
HIFU salvage treatment (if prostate cancer returns after previous radiation therapy or primary HIFU)
Who is not eligible for HIFU treatment?
If you have prostate cancer staged as advanced or metastatic (spread), HIFU is not an option.
Suppose you have a large prostate gland. Whole prostate HIFU may still be possible, but the prostate needs to be reduced through surgery or hormone therapy. Focal HIFU in large prostates will depend on the location of the prostate cancer (how close it lies to the ultrasound probe).
How do I prepare myself for HIFU treatment?
Do not eat anything for at least 6 hours before the focal therapy.
Do not drink anything for at least 2 hours before the procedure.
Attend the hospital about 2 hours before treatment time
You will be asked to change into the hospital gown and wear stockings to decrease the risk of clots in deep veins. Nurses will do preoperative checks and written consent for the HIFU procedure will be obtained by your consultant. The anaesthetist will walk you through the general anaesthetic.
The caring nurse gives an enema to empty the large bowel's lower part.
How is HIFU performed?
A HIFU probe is introduced through the back passage. The prostate gland is visualised. The ultrasound energy is directed to a specific area, sparing healthy tissue or the whole gland, depending on the prostate cancer. High-frequency sound waves generate heat that kills cancer cells. Typically, HIFU treatment takes up to two hours.
What happens after the focal HIFU treatment?
Your anaesthetist will wake you up. You can expect to feel dazed or confused for up to an hour.
You will have a catheter to make sure you empty the bladder properly. Your caring nurse will explain catheter care. A day for removal of the catheter is concorded upon. Once the catheter is removed, most people can return to work.
Your NHS consultant or private urologist will visit you and explain how the HIFU treatment went.
You will go home on the day, typically within 4 hours. You will be asked to stay overnight if your recovery does not progress as usual. Painkillers and antibiotics will be provided. A discharge summary with contact details will be provided. It takes two weeks to recover from the HIFU procedure. Tiredness is a common complaint. Take power naps, have a balanced diet, and do not overdo it.
Expect some level of blood-stained urine and blood clots. Prostate tissue fragments commonly pass in your urine on and off for up to 2 months. Ensure you are always hydrated, typically a glass of water an hour. If bleeding is frank and not clearing, do visit the emergency department.
A follow-up review in 3 months will be organised. You will be asked to take a PSA blood test.
A multiparametric MRI for the prostate gland will be organised 12 months after the HIFU procedure. This will determine whether the localised prostate cancer has been treated successfully.
What are the benefits of HIFU
· Good cancer control
· Focal therapy
· Day case outpatient procedure
· Fast recovery time (on average 3 days)
· Well tolerated
· Minimal risk of incontinence (98% fully continent at 2 weeks)
· Erectile function is maintained in 95% of men
· Salvage HIFU can be performed
· If initial HIFU has failed, the option of radiotherapy or surgery can be explored
What are the side effects?
· pain (localised to the testicles and back passage)
· Blood or small pieces of prostate tissue in your urine
· Erectile Function Issues
· Urine infection or urinary tract infection (UTI)
· Urinary problems: difficulty passing urine and empty bladder
· Urinary incontinence
· Infection in your testicles
· Rectal Fistula. This happens rarely. A rectal fistula is an abnormal communication between the bladder and rectum.
HIFU prostate cancer treatment costs the UK
The initial consultation can be anything from £200 to £250.
On average, the HIFU Focal Therapy procedure costs around £15,000.
(These approximations can vary depending on where you get your treatment for prostate cancer.)
This treatment is not routinely available in all NHS hospitals.
If my prostate cancer returns, do I still have the option of surgery?
If focal therapy fails, that is, when prostate cancer returns, one can explore radical prostatectomy (which may be challenging as the planes may be inflamed and stuck) or radiation therapy. Salvage HIFU procedures may be possible in some instances.
Is there an alternative focal therapy treatment option?
NanoKnife IRE is an alternative focal treatment. Nanoknife cannot be considered a standard treatment, as more research is needed to cement it as an alternative standard option. So far, this treatment is to be considered experimental.
Are HIFU and NanoKnife IRE the same?
Both are day-case treatment options for localised prostate cancer performed under general anaesthetic with fast recovery time to normal activities.
Both require a catheter to drain urine. If you received NanoKnife, this would be removed in a week.
Similar to HIFU, one needs to establish that you are fit and that your prostate cancer (based on your MRI scan and biopsy results) is suitable to be managed with NanoKnife IRE.
NanoKnife Fast works by electrical pulses, which pass through electrodes placed around prostate cancer guided by MRI scans. These damage the prostate cancer cells’ membrane. Hence, damaged prostate cancer cannot survive. This is how NanoKnife kills prostate cancer cells.
NanoKnife does not generate heat, as opposed to ultrasound waves. This is possible through short-lasting rapid pulses, which leads to the preservation of the surrounding healthy prostate cells with minimal side effects.
What clinical trial supports NanoKnife as an alternative approach?
An Australian study looked at Nanoknife and followed up men for 6 years. There was a 97% success; however, 15% recurred within 5 years, and 3% needed complete gland treatment within 3 years.
The treatment approach is not associated with problems passing urine, as only 1% needed treatment. 25% of the patients suffered from sexual issues. The fewer side effects compared to other treatments were limited, and patients preserved an overall good quality of life.
Compared to HIFU prostate cancer treatment, when can I return to work?
Within 48 hours, most men return to their working lives.
Recurrence after NanoKnife: can I have additional treatment like HIFU?
Around 25% of the patients require additional treatment due to cancer recurrence.
NanoKnife does not exclude you from exploring further treatment with HIFU, radiation therapy, or robotic surgery. The surgical procedure can be more challenging as the planes become inflamed and stuck.
Does health insurance cover NanoKnife IRE?
Nearly all the major healthcare insurers in the UK cover NanoKnife IRE treatment.
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