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Why is HIFU better?
  1. Lower complications and side effects
  2. Proven efficacy in studies (patient selection is important)
  3. HIFU is repeatable
  4. Short hospital stay (usually overnight)
  5. Fast recovery time
  6. HIFU can be used before or after other forms of treatment

Click above for more details on benefits of HIFU

  
1) Lower complication and side effects
Advice based on our own prospective data of HIFU treated patients
a) Short term complications
  • 20-30% of patients may experience difficulty in voiding urine and may require the catheter for an extra week, failing which they would require a cystoscopy as a day procedure to clear the dead tissue from the prostate. Our own studies on HIFU treated patients showed no overall increase in urinary symptoms up to 12 months after treatment.
  • A small number of patients may experience mild redness or swelling around the scrotum and penile skin that resolves within a week.
  • 7% patients experience mild rectal symptoms such as bleeding, loose stools or mucus in stools that resolves within a week.
  • 1% of patients have risk of a rectal fistula, which is a communication between the prostate and rectum due to overheating of the rectum during HIFU. This complication may require surgical correction. (The safety features within HIFU technology have now minimized the risk of this complication)
b) Long term complications
  • Urethral stricture risk 9%, which may require urethral dilation or incision.
  • Urinary incontinence risks
  • Stress incontinence requiring a pad 8% (leak with cough, sneeze or straining)
  • Incontinence requiring urethral injection Macroplastique 1% (urethral bulking agent)
  • Overall normal continence 88% after HIFU
  • Erectile Dysfunction
  • Sexual/erectile function assessed with IIEF self administered patient questionnaire (International Index Erectile Function) showed overall sexual activity reduced by 20%, and specific erectile function reduced by 25% at 6-12 months after HIFU.
  • The risks of HIFU compare very favourably with Radical Prostatectomy and are comparable to Brachytherapy/Radiation Therapy.
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2) Proven efficacy as Prostate Cancer Treatment

Following successful HIFU treatment patients are evaluated with PSA blood tests, and in some cases a repeat prostate biopsy. The objective is to achieve PSA <0.5 with either no further increase in PSA level and/or negative repeat prostate biopsy.

This is referred to as clinical disease free survival.

Long term data on prostate cancer specific mortality rates are currently not available.

Selected Reports of Efficacy HIFU treatment Localised Prostate Cancer.
(Ab = Ablatherm, Son = Sonablate)
Study Device N Mean
Pre HIFU
PSA(ng/ml) 		Gleason
Score 		Stage Median
Follow up
(months) 		Negative
biopsy
after HIFU 
Chaussy 2001 Ab 184 12 T1-2 80%
Thuroff 2003 Ab 402 10.9 2-4 (13.2%)
5-7 (77.5%)
8-10 (9.3%) 		T1-2 13 87.2%
Blana 2004 Ab 146 7.6   T1-2 22 93.4%
Uchida 2005 Son 72 8.1 T1-2 14 68%
Uchida 2006 Son 63 11.2 2-4 (21%)
5-7 (73%)
8-10 (15%) 		T1-2 23.3 87%
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3) HIFU is repeatable
Some patients may not achieve complete prostate ablation after the first HIFU treatment, and this would be evident as PSA >0.5 and a repeat prostate biopsy indicating viable tissue.

This may be due to technical reasons such as prostate size and prostate calcification. These patients can undergo a repeat HIFU with the intention of achieving complete ablation of remaining viable prostate tissue.
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4) Short hospital stay
Patients are taught self care of the urinary catheter before the procedure, and usually only stay in hospital overnight. Patients then return for removal of the catheter within 5 –10 days.

Catheter care and removal is under the supervision of our Oncology Nurse in the Urology suite.
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5) Fast recovery time
HIFU is not a painful treatment and the majority of men are back to usual physical activity within a week.
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6) HIFU can be used before or after other forms of treatment
HIFU can be used as salvage treatment for men who have failed previous radiotherapy treatment.
If HIFU was used as a primary treatment and there is treatment failure, patients can then opt for other forms of treatment such as prostate surgery (radical prostatectomy) or external beam radiation therapy.
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