(HIFU) High intensity focused ultrasound
High Intensity Focused Ultrasound (HIFU) works by generating small areas of energy about the size of a grain of rice. The release of this energy within the prostate causes the tissue to heat up. This change in temperature destroys the prostate cells and any cancerous cells in the area. The small treatment areas can be very carefully located within the prostate, thereby avoiding the delicate organs that lie next to the prostate gland.
HIFU is an experimental treatment that has been in use since about 2000. Research studies show that HIFU therapy is at least as safe as other treatments for early prostate cancer, and may have fewer side effects. It also appears to be effective in controlling prostate cancer, though the studies that have shown this are relatively new.
The best results are seen in treating "low-risk", localised prostate cancer. The prostate must be relatively small (less than 40cc) and not contain much calcification. These criteria limit its suitability for many patients.
Men may have their treatment and then go home a few hours later, provided someone else is at home and suitable transport can be arranged, but others stay in hospital for at least a night or two. We talked to one man five weeks after he had experienced this new HIFU treatment. He was taking part in a clinical trial to help assess the results of therapy.
Were you given a choice of anaesthetic?
I was told that the normal thing was to have an epidural and a light general anaesthetic. And that is what happened as I understand it.
So you had the epidural while you were awake?
No the epidural was given whilst I was asleep.
Yes and having woken up, I suppose sometime about two, the first, really I was conscious of was being brought back to my own, my own bed in the ward. So from the time I was outside the theatre I had no consciousness of it till I as back in the ward. And I seemed to wake quite quickly and easily and with very, very little sensation. In the evening I was given a couple of Paracetamols and that really was the only analgesic that I had during the time I was in the hospital. And I was advised to have Paracetamol if I wished but I never felt the need for it. One small thing that I mentioned to them I took Arnica with me, which is something which as a family we've used in times of sort of injury or trauma and it's in the past worked very well and I think possibly in a small way helped with this. But I think the procedure does not entail a lot of pain, it didn't, it didn't with me.
Yes I did. I had a catheter in and I think that was the, sort of the main, main difference. I mean I obviously didn't feel totally normal but I wasn't in pain. But...
And how soon could you get out of bed for example?
I think they helped me down the passage to the toilet sort of later on that afternoon, just to make sure that I was okay. But apart from that, from then onwards either later on that afternoon or I think I woke up actually quite early on the following morning, something round about five, and I went off and had a shower because I felt sort of like it was a good idea. So there was no problem with that and I was in no discomfort moving around, apart from the general sort of thing about catheters I'm sure other patients have said the same that a catheter is sort of restricting.
And the back passage, how did that feel?
I had two enemas before the treatment and it appeared to me that the effect of the enema went on for two or three days because they were very keen for the, for me not to be constipated and, which perhaps would affect the procedure's healing afterwards and that is what happened. And I hadn't been eating masses of fruit or anything of that sort.
And was it uncomfortable having your bowels opened?
Not at all, no not at all.
No good. So you were just in for the one night?
I was in before, for the one night and then they kept me in overnight afterwards and I was released around about midday the following day.
So the immediate side effects were very little?
Very little, very little. I mean it's a miraculous procedure, I mean if it works, and obviously I don't have the results yet, it is a sort of a massively different thing from surgery and apparently from radiotherapy too.
Did the doctor tell you at the time or the next morning how it had all gone?
Yes he said it went fine, yes he said it went fine. I think they know hardly any more than anybody else whether it's been successful at the stage it's done. I was told at one stage that they could not judge which patient would be successful or not.
Really you can sort of blow up anything into a great thing. I mean a catheter is something you can live with but I had it in for two and a half weeks and I was really glad when it came out. You don't move freely, walking with a catheter is, is, it's not sort of ideal but you can get around, you're not in great pain, just a little bit uncomfortable.
You had a bag strapped to your leg?
To begin with in the hospital it was just hung on a rack alongside and then subsequently they gave me a bag for my leg and that's how I left hospital.
What other sort of side effects did you notice since you'd been home, did you have any other problems?
Really very few. I mean I was warned that I should expect both blood and sort of debris in my urine, which I have had. And even now, nearly five weeks after, I get the odd trace of blood at the start of urination, but only a drop or two, nothing now very much.
It's been very much more free to move around and a wonderful relief not to have the thing. And I've been able to do everything much more. I suppose bladder function has been sort of steadily improving during the time which is nice but it's about two weeks since it came out and one of the things, the sort of side-effects is after the catheter comes out if you need to urinate you've got to do it quite quickly. One of the effects I think of the HIFU is that the tissue being destroyed has to come out of you. Apparently some comes through your urine and some is absorbed back into the, the body and excreted through the liver. And every day it is easier, over a period of about a fortnight, so that today I went and had a half round of golf, and by not drinking too much before I went I did the nine holes without having to go to the favourite spot on the course [laughs].
So there hasn't been any real incontinence then?
No just dribbles you know sort of...
Mm getting better?
Yes that's right.
That's excellent and how are you feeling in yourself sort of strength-wise?
Well today I wouldn't have wanted to do eighteen holes but I think in about a week or two's time I shall.
That's good. Anything else you want to say about HIFU?
I really do think it's a fantastic treatment. I obviously don't know yet whether it's been successful but if it has the same success rate as the other treatments I can't help thinking that it will replace the other treatments. But it has the restriction that the size of the prostrate, prostate, has to be within certain limits in size so advanced tumours perhaps may not be treatable by it.
One of the side effects which men worry about, and I certainly did myself was the effect of the possibility of impotence. And I'm very happy to say [laughs] that in, during our small holiday in the last five days, my wife and I have made love and you know it isn't necessarily a side effect of this treatment which has made me very happy.
It is important to note that this is only one man's experience of HIFU.
“this procedure should only be used with special arrangements for clinical governance, consent and audit or research.” And “Ensure that patients and their carers understand the uncertainty about the procedure's efficacy and the risks (specifically the risk of sexual dysfunction), and provide them with clear written information.”