HIFU (High Intensity Focused Ultrasound)

HIFU (high intensity focused ultrasound) is a non-surgical treatment method that uses high-intensity focused ultrasound waves to destroy diseased cells in prostate tissue. HIFU stands out as an effective alternative, particularly in early-stage prostate cancer or recurrent prostate disease.

What Is The HIFU Method?

HIFU (high intensity focused ultrasound) is a non-surgical treatment method that destroys diseased cells using high-intensity focused ultrasound waves. Since the disease destroys cells with heat, no surgical incision is required. This allows the application to be made only to the targeted area, while protecting the surrounding healthy tissues as much as possible.

HIFU's energy source is sound waves. These sound waves converge in the diseased area within the prostate, generating heat reaching 60-100°C. This procedure is called "thermal ablation," and it involves destroying tumor cells with heat. 

By precisely calculating the targeted tissue, the treatment is applied to focal areas instead of the entire prostate. The procedure is typically performed via a transrectal probe (inserting a probe through the rectum) and is guided with millimeter precision using real-time imaging (USG or MR fusion planning).

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In Which Diseases Is The HIFU Method Applied?

HIFU technology is most commonly used in the treatment of prostate cancer. It is preferred as an alternative or complementary treatment to surgery, especially in early-stage localized prostate cancer, i.e., when the disease has not spread outside the prostate. HIFU destroys the tumor area by heating it with focused ultrasound energy, while minimizing damage to surrounding healthy tissues.

Additionally, HIFU may be preferred in cases of prostate cancer that recurs after surgery. For patients who have previously undergone radiotherapy or surgery, it offers the option of local treatment without requiring another major operation. HIFU can also be used in benign prostatic hyperplasia (BPH). The aim here is to reduce the excess tissue, thereby facilitating urine flow. 

In short, the HIFU method can be used in the following situations:

• Early-stage localized (non-metastatic) prostate cancer
• Recurrent prostate cancer after surgery or radiotherapy
• Benign prostatic hyperplasia (BPH)
• Reducing prostate tissue in patients unsuitable for surgery.

In What Situations Is HIFU Not Preferred? 

HIFU treatment is not suitable for every patient. The method should not be applied in the following situations:

• In cases where the prostate volume is excessively large, closed prostate surgery (such as TURP) may be required before the procedure.
• The rectal structure being too narrow may prevent the application of the HIFU probe.
• The presence of numerous stones within the prostate can cause the ultrasound energy to scatter, reducing the effectiveness of the treatment.

Which Patients Are Suitable For HIFU Treatment?

HIFU treatment is particularly used in patients diagnosed with early-stage localized prostate cancer. These patients are those in whom the tumor is confined to the prostate gland and has not spread to lymph nodes or other organs. 

Patients who carry a high risk of surgery, cannot undergo general anesthesia due to additional health problems such as cardiovascular disease, or cannot tolerate a long recovery period are also suitable candidates for HIFU. Because this method does not involve major surgery, it can be safely applied to patients who are elderly or whose health condition makes them unsuitable for surgery.

HIFU can also be applied to patients who have previously undergone surgery or radiotherapy and experienced a recurrence of the disease. This procedure is called "salvage therapy (HIFU)" and offers a treatment option without the need for a second surgery. In addition, HIFU may be considered in some cases for patients with benign prostatic hyperplasia (BPH) who have not benefited from drug treatment.

How Is HIFU Applied?

HIFU treatment requires a prior preparation process. PSA levels, biopsy report, imaging (MRI), and prostate volume are analyzed. To prepare for transrectal (rectal) insertion, an enema is usually administered to cleanse the bowel. A catheter is inserted at the beginning of treatment to drain urine from the bladder.

A mild dose of sedation/anesthesia (enough so the patient doesn't feel pain) is administered before the procedure. Once all preparations are complete, the patient is usually placed in a supine or side position with their legs spread apart. The ultrasound probe is gently inserted into the rectum; the device's focal point is directed into the prostate. From this point on, the target area is mapped using real-time ultrasound. 

The target area is heated to a temperature between 60-100°C. Energy pulses lasting seconds are delivered to each focal point; the device software controls the energy dose and duration. A temporary urinary catheter (1-7 days) is usually inserted at the end of the procedure; it is removed when the swelling subsides. Depending on the area to be treated and the size of the prostate, the procedure generally takes 1-3 hours. 

What Are The Advantages Of The HIFU Method?

Today, HIFU treatment, which is frequently used especially in early-stage prostate cancer, has many advantages. Its most important advantage is that it offers a targeted treatment that does not require incisions in the body and preserves surrounding tissues. The main advantages are:

• No surgical incisions are made in the body.
• It is targeted; only the tumor area is treated.
• Surrounding healthy tissues are preserved.
• Hospital stay is short.
• It allows for faster recovery and return to daily life.
• It can be reapplied if necessary.
• It helps preserve sexual function.
• It contains no radiation.
• The risk of complications is low.

What Are The Side Effects Of The HIFU Method?

Despite its non-surgical and minimally invasive nature, HIFU treatment can have some side effects. Side effects are generally mild and resolve spontaneously within a short time. These side effects include:

• Burning sensation while urinating, frequent urination, or weak urination stream.
• Urinary incontinence
• Difficulty or decreased erection
• Temporary blood and tissue fragments in urine
• Mild discomfort associated with catheter use.
• Urinary tract infection or inability to urinate
• The movement of semen towards the bladder during ejaculation (retrograde ejaculation)
• Very rarely, a fistula can form between the urethra and the intestine (anal canal).

Frequently Asked Questions About HIFU

How Long Does The HIFU Procedure Take?

Treatment typically lasts between 1 and 3 hours, depending on the prostate size and the targeted area.

Is HIFU Treatment Painful?

The procedure is painless as it is performed under general or spinal anesthesia; mild discomfort may be experienced afterward.

How Long Does It Take To Return To Normal Daily Activities After HIFU Treatment?

Most patients can return to their normal lives and work within a few days.

What Is The Follow-Up Process Like After Treatment?

During the follow-up process, a PSA test, clinical examination, and prostate MRI if necessary are performed every 3 months.