Frequently Asked Questions
HIFU stands for High Intensity Focused Ultrasound. HIFU is a non-invasive
acoustic ablation technique that uses intersecting, tightly focused ultrasound
waves to raise the temperature of the target tissue to more than 80-90
degrees Celsius in two to three seconds, effectively destroying the targeted
HIFU is a non-invasive therapy
device that is approved in Europe, parts of Asia, and Central
America for the treatment of localised prostate cancer and
benign prostatic hyperplasia (BPH) or prostate enlargement.
intersecting tightly focused ultrasound waves, the HIFU
device destroys tissue and leaves surrounding cells untouched.
In addition to being non-invasive (no incisions or punctures),
HIFU energy is non-ionizing clean energy that can be applied
repeatedly without damaging other tissue, unlike radiation
based therapies. HIFU technology allows a physician to
see a live image of the prostate, then target and ablate
the entire prostate without affecting the surrounding tissue.
HIFU energy works like a magnifying
glass and sunlight. Using a magnifying glass you can focus
energy of the sun and concentrate it over a focus point while
allowing safe and harmless energy transfer over the entire
course of that beam up until it reaches the point of concentration.
What equipment is used?
HIFU treatment is performed using a Sonablate® 500
which is manufactured by Misonix Inc. (NASDAQ: MSON) of
Farmingdale, New York.
The Sonablate® 500
is approved in many countries outside the U.S. as an
image-guided acoustic ablation device developed by
Focus Surgery to treat prostate disease.
The technology behind the device originated
at the Indiana University School of Medicine in Indianapolis
in the 1970's. It was further developed in leading research
centres across the globe.
In 2001, the Sonablate® 500 received
its CE Mark for European distribution and its MHW approval
Recent studies in Europe have shown
that in 88% of the patients studied, HIFU technology
produced PSA measurements below 1.0 within one year following
treatment with a lower incidence of erectile dysfunction
and urinary incontinence than reported in studies of
The Sonablate® 500 allows a trained
urologist to visualise the prostate and plan and monitor
the treatment in real time, ensuring maximum precision,
flexibility, safety and control for the clinician.
are the results of HIFU treatment?
In approved countries, 88-99% of patients have PSA less than one after
one year. Treatment may be repeated as necessary. Recently the Journal
of Urology published an article authored by Dr Wieland and Dr Blanna
from the University of Gegensburg (Germany). The study included patients
with a five-year follow-up and showed 93.4% constant negative biopsies
in the patient population and with only two patients having a PSA level
that rose to greater than four. Publications by Dr Toyoaki Uchida, M.D.,
from Tokai University Hospital and John C. Rewcastle, PhD from the Department
of Radiology, University of Calgary in Canada reported very similar positive
the benefits of HIFU treatment?
Real time imaging and treatment of the prostate with HIFU offers the
possibility of very low rates of erectile dysfunction and negligible
rates of incontinence. Neurovascular structures responsible for erectile
and continence can be imaged, and the treatment can be designed to avoid
treatment of these sensitive areas. The precise results of clinical studies
depend on the surgical protocol adopted by the researchers, but an overall
average assessment is the less than 20% of men will have erectile dysfunction
and in a recent data series from Dr Uschida, less than 1% of men had
an incontinence problem. It is likely that with the technology now available,
the rates of erectile dysfunction in patients treated in prospective
studies, will be considerably lower.
HIFU is delivered using an epidural anaesthetic
(or a general anaesthetic if chosen) and is an out-patient
procedure. There is no radiation or cuts, and it is a pain-free
What is the recovery time?
Recovery involves wearing a Foley catheter for a week and patients usually
can return to a normal lifestyle almost immediately after the two to
four hour procedure.
What are the side effects?
Erectile dysfunction can occur in some men. Incontinence is uncommon.
Urethral strictures, epididymitis, and rectourtheral fistulas are rare.
Who can be treated?
- Men who have been diagnosed with T1 or T2
carcinoma of the prostate.
- Men under 80 years of age.
- Men with a life expectancy of five or more
- Men who have had fewer than seven core prostate
- Men with Gleason score 7.
- Men with a serum PSA less than 20ng/ml.
- Men with a prostate volume less than 40cc.
Who cannot be treated?
- Men with evidence of metastatic disease.
- Men with an inability to tolerate a transrectal
- Men with latex allergies.
- Men with any active urinary tract infection.
- Men with functional bladder problems.
- Men with intraprostatic calcifications over
1cm in size.
- Men over 80 years of age.
Who performs the procedure?
Mr Mark Emberton, Senior Lecturer in Oncological Surgery, Institute of
Urology, University College Hospital, London, and Director of the Clinical
Effectiveness Unit, Royal College of Surgeons. Five other surgeons
are being trained, including Mr Simon Brewster at Oxford Churchill
Hospital and Mr Henry Lewi at Springfield Hospital, Chelmsford.
What should I do next?
Contact Mr. Lewi's
secretary (Mrs. Esther Kendall) on 01245 234087 to
arrange an outpatient appointment or email Mr. Lewi on
for further information. Sister Sarah Buttle (Urology Specialist Sister)
is also available for advice on 07905 428836 or via the secretary on