HIFU: A newer option for men with localized prostate cancer

 Richard Ridington 

If you’re considering treatments for localized prostate cancer, there’s one option you may not know of: High Intensity Focused Ultrasound (HIFU).  I am not a medical professional, but one patient who can say why he found HIFU an appealing choice, then suggest some ways you can learn more. (But if your localized cancer is not deemed clinically significant, consider active surveillance rather than HIFU.)

            In 2016, I chose HIFU to treat my own prostate cancer because it was relatively free of the side effects that come with surgery and radiation treatments.  HIFU was first used to treat other forms of cancer, then became widely used for prostate cancer in Europe and Japan.  In 2015, a HIFU device received FDA-approval in the U.S.  HIFU works by heating tumors, thereby destroying them and a safety margin of tissue around them. Its ultrasound remains non-destructive until it reaches the point in a prostate where the urologist focuses it, where it creates about 200 degrees of heat to destroy cancerous tissue. 

            While I was under sedation, a urologist inserted a HIFU device in my rectum, then used an MRI image (taken earlier) to aim the ultrasound waves.  I was treated at about 10 am, got a ride home about 1 pm, then (with a catheter in for 4 days) went about my business (and took no pain medication).  About a quarter of my prostate gland was treated, and I’ve had follow-up tests done at a large medical center near my home in the 3 years since (nothing suspicious has been found).   I’ve had no change in erectile function, nor any of the urinary or bowel problems that commonly attend surgery or radiation therapy.

            I think HIFU has 2 drawbacks.  First: The research studies extend for only 5-10 years, versus studies for surgery and radiation that extend twice that long.  Since most prostate cancer is slow-growing, longer-term studies offer more assurance.  Second: Medical insurance typically does not cover HIFU (Medicare did, but in 2019 withdrew most of that coverage), and its cost runs up to $25,000. (While HIFU clinical trials have occasionally come available that decrease that cost, those are not widely available.)

            Having seen men have reoccurrences after other treatments, I know that no treatment is foolproof.  Should I have a reoccurrence, I’ll still be happy to have had several years free of side effects.  Further, I’ve seen new treatment options emerge that weren’t available back when I was treated, and that’s a plus.