High Intensity Focused Ultrasound (HIFU)

What is HIFU?

High Intensity Focused Ultrasound is a technique that is non-invasive and aims to retain good quality of life for the patient. The treatment works by delivering high-frequency sound waves. These waves deliver a strong beam that is focused directly onto the cancer within the prostate and, by heating the cells, it kills them.

It is suitable for locally confined prostate cancer T1 or T2. It is not suited for men with an enlarged prostate, although Hormone treatment may be first given to reduce its size. HIFU can be undertaken as a primary treatment with curative intent, though it is normally used to treat recurrence after radiotherapy.

What does the treatment involve?

The treatment is done under a spinal (epidural) or general anaesthetic and lasts about two hours. A probe, which emits an ultrasound beam, is placed in the back passage.The tightly focused beams raise the temperature of the prostate tissue to destroy the cancer cells in the targeted area without damaging the surrounding tissue. The process is repeated until the cancerous cells have been destroyed. As the prostate swells immediately after the treatment, a catheter needs to be inserted and remains in place for up to two weeks.

Focal HIFU

Results obtained in treating the whole prostate have not been ideal. However, HIFU offers the option of treating just the part of the gland where the cancer is localised to a particular area, called Focal HIFU. Precisely locating the cancer can nevertheless be difficult despite modern mpMRI diagnostic techniques. There are many trials looking at this approach which, although not proven, may offer advantages to some patients. NICE supports the procedure as being safe, although the effect on quality of life and long-term survival is unproven.

     Advantages and disadvantages

    • Repeat treatments are possible if the cancer recurs
    • Normal activity can be resumed within a few days
    • No incisions are required, and there is no radiation toxicity
    • Impotence rates, against other treatments, are often better


    • Repeat treatments carry a greater risk of impotence and incontinence
    • There may be temporary urinary retention, urgency or leakage
    • The catheter may be in for longer than for surgery
    • It is not always certain that the cancer is all localised to the treatment area
    • Occasionally self-catheterisation may temporarily be needed

Note: There is no long-term data on the effectiveness of this treatment. It is only available at a few centres in the UK and is only obtainable on the NHS in the context of a clinical trial.