A thorough review of HIFU, or High-Intensity Focussed Ultrasound, a form of ablation which uses sound waves as a non-invasive, non-surgical heat treatment for prostate cancer - including treatment details, applicability, side-effects, treatment centres and costs.
HIFU offers dramatically reduced side-effects and a cure rate of over 95%; it is thus an effective alternative treatment to standard prostate cancer surgery or radiotherapy. Learn more.
HIFU and ablation can melt away localized prostate cancer
Ablation is the use of heat to kill cancer tumours; it is localised Hyperthermia. It comes in several forms; for example thermal ablation or radio ablation where Doctors heat the cancer cells to 45, 50 or 55 degrees C; and there is cryoablation where doctors use a freezing gas at -40 degrees C. In both cases, a probe is inserted through a tiny (3mm) hole made in the skin.
High Intensity Focused Ultrasound or HIFU uses the frequency of sound waves to heat up the cancer tumours and kill them. No probe necessary. The procedure may last just 90 minutes and patients can return home in a few days. But the biggest benefits are that it is effective and far less likely to cause impotence or incontinence than surgery; or damage to other tissues such as the rectum like radiotherapy.
HIFU is thus a highly effective alternative to radical prostate cancer surgery (Radical Prostectomy).
At CANCERactive, we have championed HIFU since 2005. We were the first UK Cancer Charity to do this.
HIFU is a type of ablation
First, let's get the terminology clear.
Hyperthermia is an approved complementary cancer treatment recommended by both the National Cancer Institute and Sloan Kettering in New York. Since William Coley in 1920 at Sloan Kettering, it was originally thought of as a whole body treatment.
Ablation is the localised form of hyper thermia. As we said above - Thermal Ablation uses heat to kill local tumours. Cryoablation uses a freezing gas.
Focal Laser Ablation can be used to treat prostate cancer. The cancer needs to be confined to the prostate, the Gleason 4/3, or less, and the patient is sedated. The 1.6 mm laser is then inserted under anestheic into the prostate, guided by MRI imaging. Before treatment you will have had an image guided biopsy. There are a good number of Laser Prostate Centers in America; increasingly all major Hospitals use it.
In the UK we have the Focal Therapy Clinic, and that's about it! See the end of the article for details.
HIFU is a non-invasive way of delivering the heat to kill tumours and thus is a largely non-invasive form of Thermal Ablation. Most centres do use a catheter, a drain, to take away blood from the area though during HIFU. You may also be given antibiotics.
The Slow Development of HIFU in the UK
Back in 2004, in icon magazine, we first covered the news of this ’breakthrough’ therapy called HIFU, a form of Ablation being mentioned by the British Media as a future breakthrough treatment for prostate cancer. On March 18th 2005 there was the Istanbul conference, and the European Association of Urology (EAU) launched a ’club’ of top Urologists across Europe to support and develop this highly promising, non-invasive treatment. As Chris Woollams, a founder of CANCERactive and a former Oxford University Biochemist, says, "They wrote to me asking if I would look into the treatment and support it if I liked what I found. I did more. I have ’Championed’ it for the men of Britain repeatedly in CANCERactive! But prior to 2022 it barely got off the ground in the UK. Politics has been a huge factor. Fortunately that is changing."
You can see a video interview of Chris Woollams with Professor Robert Thomas on the Chris Woollams YouTube channel.
In its simplest form, private clinics in Europe started using Ablation back in 2000, for example using a plastic catheter pushed up the penis to position a metal probe into the middle of the prostate. This could then be heated killing the surrounding cancer cells. Simple, cheap, effective. By 2005 over 7,000 patients had been successfully treated using this therapy in places such as Germany, Switzerland and Russia. There were claims of 100% effectiveness or 75% if you had had a biopsy. You were also commonly given Androgen Deprivation Therapy for a year or two, so it was rather hard to be clear about what was working.
Go to: Richard Beavan goes to Klinik St. George for Prostate Ablation
By 2009 Clinical Trials on HIFU in the UK, taking newly diagnosed prostate cancer patients (where the cancer was small and confined to the prostate), showed that although surgery was effective with these people (although not recommended by the likes of Sloan-Kettering and the Royal Marsden, who preferred ’Active Survilance’), HIFU was just as effective as existing treatments and had the advantage of significantly lower levels of side-effects. At that time a wider Clinical Trial was started at MD Anderson in Texas.
By 2018, a Directory of Locations for Ablation showed that the USA had 254 centres, Germany 46, France 66.
We had just two in the UK for HIFU, and one of those in Southampton seems to have closed already. A number of UK Hospitals do offer ablation and cryoablation, but not for Prostate cancer.
HIFU for prostate cancer - would you qualify?
The first thing to understand is that your tumour should be confined to the prostate and within the capsule, if you are considering this treatment. You usually will only be treated in the UK if your Gleason score is a maximum of 7 (4+3 or 3+4).
* Biopsy or MRI?
Next, as we said above, although some German clinics talk about 100% success in terms of ablation killing the cancer cells, they lower this figure to 75% if you have had biopsy. Why? Because biopsy can spread a prostate cancer as it punctures the capsule around the prostate, allowing cancer cells to escape. Many of them require patients to take an androgen suppressing drug for at least a year because of possible spread. There was clear research in the nineties from Guy's Hospital, London on biopsy causing spread.
Some centres in the USA, for example First Urology in Louisville, use HIFU around the outside of the capsule to mop up escaped cells.
Increasingly, hospitals are using a new form of MRI - a Multi Parametric MRI, which gives a much clearer picture of what's going on 'down there' and can negate the need for a biopsy.
* Some US Centres for HIFU
At First Urology in the USA, Dr. John Jurige (who is based in Louisville, Kentucky), routinely extends the HIFU treatment to a small distance around the prostate in order to kill any escaped cancer cell, and claims that in 100% of cases he preserves the nerves (resulting in no erectile dysfunction) and incontinence occurs in less than 5% of patients. By 2019 he had treated over 1,500 patients with HIFU.
Go to: John Jurige at First Urology
Similar numbers have been treated at MD Anderson and the man to go to in Texas seems to be Dr James Cochran, who holds free education webinars; and the website to go to for these is - https://www.texashifupartners.com/. Dr. Cochran first used Sonablate therapy in 1999; and HIFU was approved by the FDA for prostate cancer treatment in 2015.
In Chicago, the University of Chicago immediately started using HIFU under the heading of ’robotic surgery’.
In Los Angeles there is Dr. Pugach and his assistant John Linn. They had over 1200 procedures behind them by 2019. He has a Webinar.
Go to: Dr Pugach Free Webinar on HIFU
* UK Centres as at 2023
You could contact Professor Mark Emberton at University College, London - https://iris.ucl.ac.uk/iris/browse/profile?upi=MEMBE52
You could also contact the Focal Therapy Clinic - Tel: 020 7036 8870; Website: https://www.thefocaltherapyclinic.co.uk
Guys and St Thomas' NHS Trust in London now offers HIFU - see https://www.guysandstthomas.nhs.uk/health-information/hifu-to-treat-prostate-cancer/treatment
The Nuffield, Oxford University is starting to offer HIFU - see https://www.nds.ox.ac.uk/research/hifu
HIFU treatment details - what you need to know
HIFU treatment happens just once and lasts for about one and a half hours, with patients usually being admitted the night before and leaving hospital a maximum of two to three days later. In some cases, if patients are collected, they can leave within two to three hours.
This in itself is a major benefit to patients - shorter time in hospital, being able to walk out easily and comfortably. within a few hours. One issue is that most US centers require the patient to take 12-20 days of antibiotics. Another is that a catheter may need to stay in place for as long as 20 days and hence the antibiotics. Many people in the health community would say this in itself was invasive as it might destroy commensal gut bacteria.
In rare cases, you may have the treatment twice - several days apart.
You will be told what and when you can eat; and you will be given a water enema. A probe is introduced up your rectum, while the patient is under general or spinal anaesthesia. This probe allows constant Ultrasound pictures to be transmitted to locate the exact area of infection and observe treatment, then the high intensity focussed ultrasound transmissions are applied to raise the temperature of the localised area to 85 to 100oC. This induces necrosis of the affected prostate tissue. Reports suggest that the tumour and infected cells liquefy. The treatment is a precise local treatment, involving usually just one two-three hour session and is minimally invasive with no side effects. Few complications have been reported to date and patient recovery time is short.
95% of patients have none of the problems associated with prostate surgery - they are cancer free, with no urine leak plus good erectile function
"HIFU Technology for the treatment of prostate cancer is very promising, as is demonstrated by the high rate of success that we experience in Munich", stated Dr Stefan Throff of the Krankenhaus Munchen Harlaching. That success (2019) is claimed to be 87 per cent without relapse at five years.
Another positive of the treatment is that nadir PSA is reached after only 3 months and so success is more quickly established.
UK Clinical Trial on HIFU - 95 per cent success
Sadly, some personal friends who have enquired about HIFU as a treatment in the UK have heard it ’rubbished’ by UK oncologists as if it is some sort of quackery. These people have no idea of what is going on in the world - these excerpts are from a news item that appeared in Cancer Watch (Latest News) on this website as reported in the Journal of Urology as long ago as Monday 4 April 2011.
"Researchers at UCL (University College London) and clinicians at University College London Hospitals NHS Foundation Trust (UCLH), successfully used High Intensity Focused Ultrasound, or HIFU treatment, to target only cancerous tumours and minimize the damage caused by traditional surgery or radiotherapy.
This is the first trial of its kind and the results showed significantly reduced harmful side effects and positive results in terms of cancer control.
After 12 months, 90 per cent achieved the perfect result called the trifecta status - of having no urine leak, having good erections and being cancer free. In fact, 95 per cent of the participants, all UCLH patients, were able to maintain erections sufficient for intercourse and no participants reported back-passage problems.
Early cancer control was also very promising. Ninety per cent of men had no cancer on tissue samples taken after treatment, while 100 per cent had no important cancer.
Professor Mark Emberton, chief investigator for the study and clinical director for cancer services at UCL, added, Our early trial results have shown that 95 per cent of men have none of the long term problems associated with the more invasive treatments such as leaking urine or poor sexual function. This cannot be achieved by any other standard treatments."
Go to: An exclusive interview with Professor Mark Emberton
To put this all in context, prior to this treatment’s emergence, UK 5-year survival rates for prostate cancer in 2016 were 54 per cent. HIFU certainly seems a much better and more user friendly option than traditional surgery and/or radiotherapy.
Other Prostate cancer treatment options
For those who cannot have HIFU and do not want Radiotherapy or surgery, other options do exist - notably Proton beam therapy, and Nanoknife.
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Further reading
Go to: Ablation as a cancer treatment
Go to: A review on Hyperthermia