Why Is HIFU A Beneficial Treatment For Prostate Cancer

1. Short term complications
   • Some patients experience difficulty passing urine and may require a catheter for an extra week, failing which they would require a Cystoscopy as a day procedure, to clear the treated tissue from the prostate. Antibiotics are routinely prescribed during the recovery period. Our own studies on HIFU treated patients showed no overall increase in urinary symptoms more than 12 months after treatment.
   • A small number of patients may experience mild redness or swelling around the scrotum and penis that resolves within 1-2 weeks.
   • <10% patients experience mild rectal symptoms such as bleeding, loose stools or mucus in stools that resolves within a week.
   • <1% of patients have 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 rectal cooling safety features with HIFU technology have greatly minimized the risk of this complication)
2. Long term complications
   • Urethral stricture risk <10%, which may require urethral dilation or incision.
   • Urinary incontinence risks are minimal.
   • Stress incontinence requiring a pad 2% (leak with cough, sneeze or straining).
   • Overall normal continence 98% after HIFU. No patients have required surgery for Artificial Urinary Sphincter or Urethral Sling.
   • 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 40% at 6-12 months after HIFU.
   • The risk of erectile dysfunction is further reduced where a Partial Prostate Ablation is done.
   • The risks of HIFU compare very favourably with Robotic/Radical Prostatectomy and Brachytherapy/Radiation Therapy.

Following successful HIFU treatment patients are evaluated with PSA blood tests, and in some cases a repeat prostate MRI scan and biopsy. The objective is to achieve PSA <1.0 with no further increase in PSA level and/or negative repeat prostate biopsy, and no need for further treatments.

This is referred to as Failure Free Survival (FFS).

Longer term survival data published by Royce et al, and Emberton et al, indicate survival from prostate cancer is 100% after 7 years. This is known Prostate Cancer Specific Survival or PCFS.

Failure Free Survival is 76% at 7 years and 71% at 10 years after HIFU treatment.
This means that the risk of needing further treatments for prostate cancer are about 1 in 4 at 7 years and 3 in 10 at 10 years after HIFU treatment.

Although there are no RCTs or Randomised Controlled Trials comparing survival between surgery and radiation or surgery and HIFU, the published PCFS rates are very similar.

Some patients may not achieve complete prostate ablation after the first HIFU treatment, and this would be evident as PSA >1.0 and a repeat prostate MRI scan and biopsy.

This may be due to technical reasons such as prostate size or prostate calcification. However HIFU can be repeated if necessary, with the intention of achieving complete ablation of remaining prostate tissue.

HIFU treatment does not exclude having either surgery or radiation treatment at a later time, should this be necessary.

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 3-4 days.

Catheter care and removal is under the supervision of our Oncology Nurse in the Urology Suite.

HIFU patients report occasional discomfort, but HIFU is not a painful treatment and the majority of men are back to work or usual physical activity within 2 weeks.

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 (robotic/radical prostatectomy) or external beam radiation therapy.