High-frequency ultrasound (HIFU): Prostate cancer treatment with fewer side effects

Prostate cancer is the most common cancer in men in the United States. This kind of cancer occurs when cells grow out of control in the prostate gland within a man’s reproductive system. Fortunately, prostate cancer is also among the most treatable cancers.

Through annual prostate exams, physicals and preventive prostate-specific antigen (PSA) screenings, this type of cancer can be detected early. In the past, the only treatment option was to remove the entire prostate gland or treat the area with radiation. However, there are now more focused, less aggressive options for patients with early stage, intermediate risk prostate cancer (Grade 2 or a Gleason 6-7) that hasn’t spread beyond the prostate gland.

High-frequency ultrasound, or HIFU, is one of these focal (localized) treatment options that is minimally invasive, avoids side effects and offers a quick recovery. HIFU was pioneered at the Indiana University School of Medicine with support from IU Health surgeons, and today, more than 50,000 men have been treated with HIFU worldwide.

How HIFU works

HIFU delivers heat through ultrasound waves to destroy cancer cells. During a HIFU treatment, the patient is asleep, and a probe is inserted into the rectum, which is right next to the prostate. The wand delivers focused soundwaves an inch away into the prostate gland. Much like how a lumpectomy removes a very focused part of the breast in breast cancer, HIFU uses focused heat to destroy very specific prostate cancer cells, without affecting healthy tissue nearby.

HIFU is delivered in an outpatient procedure, so patients can return home and begin an often simple and speedy recovery. The heat from the procedure does cause swelling, so patients will have a temporary urinary catheter for four to seven days after HIFU treatment.

The benefits of HIFU are that there is no incision, recovery is usually quick and patients can avoid serious side effects that come with surgery or radiation, such as urinary incontinence, leakage or erectile dysfunction (ED). The nerves that trigger erectile function run alongside the prostate, so surgery and radiation run the risk of causing ED.

“HIFU is probably the best of any treatments for preserving sexual or erectile function. The risk of having severe ED after HIFU is less than 2%,” said Dr. Clint Bahler , urologist at IU Health. “Other than having the catheter, there’s really no recovery following HIFU. An advantage of HIFU is you’re basically back to work immediately with no lifting restrictions, no travel restrictions and no incisions, so no risk of hernias. There’s also really no pain associated with the procedure.”

There are other localized, less invasive prostate cancer treatment options like HIFU, such as cryotherapy and Irreversible Electroporation (IRE) therapy. However, HIFU remains the most widely used and accepted therapy with the most data to support it.

Around 80% of patients have good outcomes from HIFU treatment. Other patients may have cancer that requires additional treatment. These patients could repeat HIFU again or move on to robotic surgery or radiation therapy. Patients who have HIFU will undergo active surveillance of their prostate, including twice yearly PSA screenings and imaging, such as an MRI, every couple of years to monitor for cancer.

Expanding the use of HIFU through research

Physician researchers at the IU Health Academic Health Center are expanding the use of HIFU by investigating it as an effective treatment option for other urological issues, like enlarged prostates. This can be caused by conditions like benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate gland that causes urinary problems.

“We’re in the process of developing a clinical trial where men who have trouble urinating (unrelated to cancer) could get a HIFU as a minimally invasive treatment,” Dr. Bahler said. “It has been noted that when HIFU is used to kill prostate cancer, the prostate shrinks in size, resulting in a stronger stream and more complete emptying. There is data showing that HIFU can be used to shrink the prostate in men with benign enlargement, reducing symptoms such as weak stream, incomplete emptying and urinary frequency.”

Researchers at IU School of Medicine are building upon their initial work on HIFU in prostate cancer to explore using advanced imaging to more accurately plan HIFU treatments. Clinical trials showed that PSMA-PET and MRI scans help doctors diagnose and treat prostate cancer earlier and with greater accuracy than traditional MRI scans alone.

Dr. Bahler and his colleagues at the IU Health Academic Health Center were among the first to use PET scans for prostate cancer, and currently have a five-year, multimillion study funded by the National Institute of Health to investigate the accuracy of PSMA for detecting the location and size of prostate cancer. They’re also looking into how PET scans can help guide robotic surgery for prostate cancer.

“Because we’re not treating the whole prostate with HIFU, only part of it, it’s even more important we understand the boundaries of the cancer so we can treat it with proper margins,” Dr. Bahler said. “The advanced imaging with MRI and PET has really helped us do that. MRI is very good at showing you the anatomy of the prostate, and the PET scan gives you a bit more information about the cancer.”

Assessing your risk for prostate cancer

Prostate cancer is often treated successfully because it is caught early. Annual PSA screenings are recommended for men ages 50 to 70. Men with average risk should begin these blood tests at age 50. Men with higher risk for developing prostate cancer—such as African American men and men with a first-degree relative (father or brother) who developed prostate cancer before age 65—should start screening at age 45.

Learn more about prostate cancer risks and symptoms. If you or someone you know develops prostate cancer, talk with your doctor about whether you’re a candidate for a localized therapy like HIFU, or whether more aggressive treatment is necessary.