HIFU, which is defined as high-density focused ultrasound (HIFU), is also known as non-surgical prostate cancer treatment.

What is HIFU Treatment?

It uses high-frequency ultrasound energy to destroy cancer cells in the prostate gland. The ultrasound energy beam travels to the prostate through a probe placed in the anus (rectum). High intensity sound waves generate heat at a certain point by focusing. The tissue temperature at the focal point of HIFU energy rises to approximately 90 degrees C in a short time and only cancerous cells and their immediate surroundings are destroyed. Prostate cancer is eliminated without any incision or radiotherapy to the body. Normal healthy prostate tissues are not damaged. HIFU is known as a minimally invasive procedure.

How is HiFU Therapy Performed?

Your treatment is performed lying on your back with your legs open under anesthesia. A catheter (urinary catheter) is inserted at the beginning of treatment to drain urine from the bladder. The boundaries of the prostate gland are determined by a probe placed in the anus and the locations of tumor cells previously detected in fusion biopsy by multiparametric MRI. Ultrasonography of the prostate is performed with the probe and paired with MRI images. It is determined by creating a safety margin around the lesion area where cancerous cells are located. The probe is given a high-intensity ultrasound energy beam to the prostate. The beam treats a small area of the targeted prostate tissue each time (in the form of a 10x3 mm cube) and is monitored on the screen of the HIFU device. The tissues with fully flammable cancer cells are seen as yellow, the ones with mild burns are seen as green, and the excess sides are seen as red on the screen. Sound waves can be sent again to several points when necessary.

Who are the Patients Suitable for HIFU Treatment?

Patients diagnosed with prostate-limited early stage (T1 and T2) localized prostate cancer, patients who do not want to experience urinary incontinence and erection problems after classical prostate cancer treatments such as radical prostatectomy and radiotherapy, patients with various comorbidities and who cannot tolerate surgery such as advanced age, patients who are still diagnosed with cancer recurrence after radical prostatectomy or radiotherapy, patients who do not want to undergo surgery, patients who cannot undergo radiotherapy and radical prostatectomy (who undergo surgery from the abdominal region)

Who are the patients who are not suitable for HIFU treatment?

HIFU treatment is not appropriate in locally advanced patients, in other words, patients with tumors that have exceeded the prostate capsule, and in patients with advanced prostate cancer with distant organ metastasis. If the patient has an active prostatitis or acute prostatitis, the procedure is postponed again. Technically, there may be a relative contraindication especially in patients with tumor localization close to the urinary tract called rectum and urethra after multiparametric prostate MRI examination. Therefore, multiparametric prostate MRIs of patients should be examined by experienced radiologists and urologists before the procedure. Another relative contraindication is related to patients with a very large prostate and severe difficulty in urinating. In these patients, HIFU can be performed with drug therapy or closed endoscopic prostate surgery by reducing the prostate.

How Many Types of HIFU Methods Are Available?

Basically, there are 2 types of HIFU methods depending on the device used. The first of these is the whole gland whole gland ablation procedure in which the prostate gland is completely treated. This method is the oldest method applied. It is more appropriate in patients with tumors in the right and left lobes of the prostate. Today, as a result of the developments and technological advances in the HIFU device, the focal-oriented HIFU method, in which only tumorous tissues are targeted, has been started to be used by preserving healthy prostate tissue. Here, only tumorous tissues are targeted and treated. It is generally more appropriate in patients with tumors in a region of the single-focus prostate. Although the procedure varies depending on the number of tumors, it takes an average of 1.5-2 hours.

What is the Return to Social Life After HIFU Treatment?

After treatment, patients stay in the hospital overnight. They can eat and walk 4-6 hours after the procedure. Since there is no open incision, movement limitation and pain are not seen. The patient can take a shower at home. It is not a problem for patients to perform their daily activities. There is a urinary catheter. The urinary catheter stays for an average of 7 days. As long as the patient remains with the catheter, he receives antibiotic treatment. In addition, it is recommended to use anti-inflammatory and alpha-blocking prostate drugs for 1 month to prevent the first edema in the prostate tissue and the difficulty in urinating due to swelling. The patient can continue his social life completely on the 10th day in total. As with all prostate procedures, long-term stays are not recommended for the first month, and care should be taken not to become constipated.

What is the Effect of HIFU Treatment on Sexual Functions?

Since it does not damage the surrounding healthy prostate tissues and vascular nerves, erection and urinary incontinence problems are less than ever. Very rarely, side effects have been reported in the literature. Another advantage of the HIFU procedure is that there is no problem related to ejaculation.

Are There Side Effects of HIFU Treatment?

Side effects are very rare. There may be urinary tract infection after the procedure, it is treated with simple antibiotics. Apart from this, mild particulate matter may be seen in the catheter due to the can-cerous prostate cells destroyed. Above-mentioned sexual dysfunc-tions are very rare. HIFU treatment is the least likely treatment among prostate cancer treatments for complications.

What is the Follow-up After HIFU Treatment?

After the procedure, an average of 7. The catheter is removed daily. Multiparametric prostate MRI is performed to see the treated area in the prostate before the catheter is removed. In addition, prostate MRI is performed at certain intervals after the treatment for control purposes. PSA levels are checked every 3 months. In the presence of clinical necessity, confirmation can be made by prostate fusion biopsy.

What is done in case of recurrence of prostate cancer in the fol-low-ups after HIFU?

If cancer cell is detected again during follow-up, there is a chance to perform HIFU procedure again. Other options are robotic radical prostatectomy or radiotherapy after HIFU.