HIFU (High-Intensity Focused Ultrasound) in prostate cancer is a non-invasive treatment that uses focused ultrasound waves to destroy malignant tissue through thermal energy. It provides a precise and organ-sparing therapy option.
The procedure is performed under imaging guidance, ensuring accurate targeting of cancerous areas while minimizing damage to surrounding healthy prostate tissue. It is often considered for localized prostate cancer cases.
HIFU offers benefits such as reduced recovery time, minimal complications, and the possibility of retreatment if necessary. It is particularly suitable for patients who wish to avoid radical prostate surgery.
Indications include localized, organ-confined prostate cancer or recurrence after radiation therapy. Long-term studies demonstrate its effectiveness in disease control and quality-of-life preservation.
| Treatment Method | High‑Intensity Focused Ultrasound (HIFU) |
| Definition | A minimally invasive treatment for prostate cancer that uses focused high‑intensity ultrasound waves to heat and destroy cancerous cells. |
| Applications | Early‑stage, localized prostate cancer; suitable for patients ineligible for or declining surgery or radiotherapy. |
| Advantages | Targets cancer cells with minimal damage to surrounding healthy tissue; lower risk of urinary and sexual side effects compared to other treatments. |
| Procedure | Under spinal or general anesthesia, a transrectal ultrasound probe is used to focus on the tumor area; ultrasound waves raise the temperature of cancerous tissue, causing cell death. The procedure typically lasts 1–3 hours. |
| Side Effects | Temporary difficulty urinating, urinary tract infection, urinary incontinence, rare rectal pain or burns; serious complications are uncommon. |
| Success Rate | High success rate in localized, early‑stage tumors; varies based on tumor size and location. |
| Follow‑Up | Regular monitoring of prostate‑specific antigen (PSA) levels post‑procedure, with MRI or biopsy as needed. |
| Alternative Methods | Radical prostatectomy, radiotherapy, irreversible electroporation (NanoKnife), cryotherapy. |
| Related Conditions | Prostate cancer, localized low‑ and intermediate‑risk prostate tumors. |
| Precautions | Pre‑procedure antibiotics recommended to reduce infection risk; PSA and MRI results guide treatment planning. |
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
Prof. Dr. Kılıçkesmez holds the Turkish Radiology Competency Certificate, the Turkish Interventional Radiology Competency Certificate, Stroke Treatment Certification, and the European Board of Interventional Radiology (EBIR). In his academic career, he won the Siemens Radiology First Prize in 2008.
What Is HIFU and How Does It Treat Prostate Cancer?
HIFU is a method that uses focused sound waves to generate high temperatures and target cancerous tissue in prostate cancer. High‑intensity ultrasound waves are directed at the tumor region of the prostate, raising temperatures above 70 °C to induce cancer cell death. HIFU’s impact on prostate cancer is notable for delivering treatment without harming surrounding healthy tissue, thereby reducing the risk of side effects while destroying cancerous tissue.
Advantages of HIFU in prostate cancer treatment include:
- Reduced Side Effects: Lowers risks of incontinence and erectile dysfunction.
- Localized Treatment: Targets only the diseased portion of the prostate.
- Short Recovery Time: Patients can quickly resume daily activities.
- Minimally Invasive: Provides a minimally invasive alternative to surgery.
HIFU is particularly effective in intermediate‑risk prostate cancer and localized tumors, offering an outpatient option. However, it may not be suitable for large or advanced tumors, and patient selection should be individualized. HIFU is considered an important option for those seeking targeted, effective prostate cancer treatment.
Who Is a Candidate for HIFU in Prostate Cancer?
Candidates for HIFU in prostate cancer must meet specific criteria. The treatment is most appropriate for localized cancer, typically Stage I or II, confined to the prostate. Ideal candidates generally fall into low‑ to intermediate‑risk categories based on:
- Low‑Risk Patients: PSA ≤ 10 ng/mL, Gleason score of 6, tumor confined to one lobe of the prostate (T1c–T2a).
- Intermediate‑Risk Patients: PSA 10–20 ng/mL, Gleason score of 7, tumor confined to a portion of the prostate (T2b).
Tumor location also matters: HIFU is most effective when tumors are located in the posterior or lateral prostate regions, allowing energy waves to reach the target easily. Tumors in the anterior prostate or in very large glands may not be suitable for HIFU.
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What Are the Benefits and Risks of HIFU in Prostate Cancer?
HIFU offers notable benefits and some risks in prostate cancer. Key benefits include high‑precision targeting of cancerous tissue without damaging healthy structures, with low likelihood of harming nerves, bladder, or rectum. Lower side effect rates—such as incontinence and erectile dysfunction—are seen compared to surgery. As a non‑invasive, incision‑free procedure, HIFU promotes rapid recovery, and many patients return to normal activities shortly after treatment. Additionally, HIFU can be repeated without significantly increasing side effect risks if cancer recurs.
Benefits of HIFU:
- Precise Targeting: Effectively destroys cancer cells while sparing healthy tissue.
- Low Side Effect Risk: Reduced rates of urinary incontinence and erectile dysfunction.
- Non‑Invasive Outpatient Procedure: No incision required and quick recovery.
- Repeatable: Can be repeated safely in case of recurrence.
Risks and potential side effects include temporary urinary symptoms, which usually resolve quickly but may rarely lead to more serious complications. Although erectile dysfunction risk is low, it can occur and sometimes be permanent. Rare complications such as urethral strictures or rectal fistulas may also develop.
Is HIFU Effective for Long‑Term Cancer Control?
Clinical studies indicate that HIFU offers promising long‑term cancer control for prostate cancer, especially in localized, early‑stage cases. In low‑ and intermediate‑risk patients, 10‑year cancer‑specific survival rates exceed 90%, highlighting HIFU’s long‑term management potential. A study of 704 patients treated with HIFU reported that 99% remained cancer‑free over 10 years.
HIFU selectively destroys targeted cancerous tissue while preserving healthy structures. Most patients do not require salvage therapies and maintain quality of life. HIFU has also been used successfully in cases that would otherwise require radical treatments, minimizing complications and facilitating faster return to normal life.
Long‑term advantages of HIFU include:
- Potential to reduce the need for surgery or radiation
- Approximately 89% of patients avoid radical treatments
- Allows retreatment in case of recurrence
What Can Patients Expect During and After HIFU Treatment?
During HIFU, patients typically receive general anesthesia to remain still and comfortable. A transrectal ultrasound probe is used to target prostate cancer tissue. MRI guidance may be used to enhance precision and protect healthy tissue. The procedure lasts about 2–4 hours.
Recovery is usually rapid, and most patients are discharged the same day. A urinary catheter is often left in place for 3–10 days to facilitate urination. Patients can resume light activities within days, and more strenuous activities after catheter removal. Full recovery typically occurs within one week.
Short‑term side effects may include:
- Increased urinary frequency
- Burning sensation during urination
- Mild discomfort
These usually resolve within days to weeks. More serious but rare side effects include:
- Urinary retention
- Erectile dysfunction
- Rectal complications
Even these are generally milder compared to surgery or radiation. Thanks to its minimally invasive nature, most patients return to normal life quickly after HIFU.
Prof. Dr. Özgür Kılıçkesmez is one of Türkiye’s leading interventional radiology and neuroradiology specialists, focusing on minimally invasive endovascular treatments. His primary areas of expertise include aneurysm and stroke treatments, embolization procedures, non-surgical treatments of thyroid and parathyroid diseases, interventional oncology, and peripheral vascular interventions. He currently serves as the Head of the Interventional Radiology and Neuroradiology Department at Istanbul Memorial Göztepe Hospital.
Graduating from Istanbul University Cerrahpaşa Faculty of Medicine in 1997, Prof. Dr. Kılıçkesmez received advanced training in interventional radiology and oncology as a Clinical Fellow at London Guy’s & St Thomas’ and King’s College Hospital between 2012 and 2013. He earned the title of Professor in 2020 and, in the same year, became the Founding Interventional Radiologist at SBÜ Çam and Sakura City Hospital. He also holds the EBIR (European Board of Interventional Radiology) certification.
Prof. Dr. Kılıçkesmez has 94 international and 40 national publications and over 2500 citations. He serves as a reviewer for prestigious journals such as the American Journal of Roentgenology (AJR) and Diagnostic & Interventional Radiology. With his clinical and academic expertise, he is a nationally and internationally recognized authority in stroke treatment, brain aneurysm, embolization, tumor ablation, and minimally invasive treatments of thyroid/parathyroid diseases.
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