High Intensity Focused Ultrasound – HIFU FAQs

Q.  How is HIFU used to treat prostate cancer?

A.  High Intensity Focused Ultrasound (HIFU) targets prostate cancer cells with radiation-free sound waves. HIFU is performed under spinal anesthesia and takes 2-3 hours to complete. Using a rectal probe, the ultrasound beam is pointed at the cancerous prostate to “paint” the prostate gland with HIFU energy while heating and destroying the diseased tissue. The destroyed tissue is later expelled from the body naturally. 

Q.  What are the disadvantages of HIFU?

A.  Most important, HIFU is not FDA approved and is not available in the United States. Men who choose to have HIFU for prostate cancer must travel to another country for the procedure without insurance support.

HIFU is performed without the benefit of real-time, first-hand visualization. Like other prostate cancer treatments, such as CyberKnife® radiation, pre-treatment from PSA testing, prostate biopsy, CT scans, and real-time imaging are used by doctors to approximate the target for the ultrasound.

Unfortunately, the data available prior to treatment can be very limited and is not always accurate. It is not until the prostate is seen first hand during robotic surgery, and tested after surgery, that the true extend of the prostate cancer is known. The type of prostate cancer, the shape and size of the tumor, and the exact location cannot be established with certainly from biopsy and scans, or from computer imaging. Surgery also affords the opportunity to fully assess the status of the lymph nodes and the seminal vesicles for any presence of cancer. 

Q.  Is HIFU effective in treating prostate cancer?

A.  HIFU presents a challenge to patients and providers, as there is a significant lack of clinical data supporting its effectiveness. HIFU ultrasound treatments are a relatively new prostate cancer option and without FDA approval they cannot be performed in the U.S.

The long-term success of HIFU in eliminating prostate cancer is unknown. Further study is needed to determine whether addressing the cancerous tissue alone, and leaving the prostate intact, is aggressive enough to provide long-term wellness and quality of life. Dr. Samadi’s robotic prostate removal surgery eliminates some of this concern, as the prostate and all visible cancerous tissue is removed from the body.

As such, HIFU may be a better prostate cancer treatment option for men who are not surgical candidates or who have undergone previous procedures, such as radiation, and are facing recurrence of their prostate cancer.  

Q.  How does HIFU differ from Robotic Prostatectomy Surgery?

A. HIFU does not remove the cancerous prostate from the body. It simple targets cancerous tissue in hope that all of the cancer will be destroyed. Men who opt for HIFU must follow a very strict regimen to track their PSA levels and watch for any additional signs of cancer. As long as the prostate remains intact, a man’s PSA level can continue to fluctuate and create concern.

With robotic prostatectomy surgery, men are offered greater piece of mind through the complete removal of the cancerous prostate. Dr. Samadi is highly experienced in this minimally invasive prostate removal surgery. His expert judgment, paired with the first-hand visual knowledge he gathers during the procedure optimizes the surgical outcomes.

Just six weeks after robotic prostatectomy surgery, men who adhere to Dr. Samadi’s post-surgical care and follow-up should have an undetectable PSA level.  

Q.  What are the side effects of HIFU?

A.  Reported HIFU side effects are significant and may include:
  • Erectile dysfunction and/or sexual impotence in 30-70% of patients
  • Ejaculation problems, including possible retrograde (internal) ejaculation
  • Urinary incontinence
  • Urinary frequency and burning
  • Rectal wall injury from probe
  • Rectal incontinence, burning, and bleeding
  • Prostate infection
  • Catheter required for up to 4 weeks following treatment
  • Risk of recurrence or prostate cancer spread between treatments

HIFU risks are increased each time the procedure is performed.

Long-term HIFU impotence risk:
Some reports indicate that as many as 70% of men are left impotent after HIFU due to risk of damage to the tiny nerves responsible for erectile function. In contrast, with optimal patient conditions, surgical results, and post-operative care only 15% of Dr. Samadi’s patients manage the same concern.  

Q. Will I need additional prostate cancer treatments after HIFU?

A. Based on its infancy, most HIFU data is only available for a ten-year period. Some studies indicate that the procedure must be reported in 10% of cases and can be done so 6 months after the first treatment.

Men considering HIFU for prostate cancer should be aware that its long-term effectiveness and comprehensive risks are not yet proven.

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* The benefits of robotic surgery cannot be guaranteed as surgery is both patient and procedure specific. Previous surgical results do not guarantee future outcomes.
Jacob G, Israel

פתאום באמצע החיים הודיעו לי שחליתי בסרטן. בבלוטת הערמונית שלי שהיא המקור ליצירת חיים ולהתחדשות, התגלה גידול ממאיר. מעבר להלם הראשוני ולחרדה הקיומית התברר לי שאני שוקע במערכת מפותלת ומורכבת של אפשרויות לטיפול ולריפוי, החל ממעקב ללא התערבות, דרך תהליכי הקרנות פנימיים וחיצוניים ועד לניתוחים מגוונים לכריתת הערמונית. להפתעתי גיליתי.

Bob B. New Milford, USA

Thanks to Dr. David Samadi and the staff at Mt. Sinai Hospital for giving me my life back.

Dillion F,

"From 2005 to 2010 my PSA increased from 2.5 to 4.5 when I got a first prostate biopsy showing a low percentage of cancer cells in a couple of cores and Gleason score of 3 - 3.  I determined to stay with watchful...

Steve S. New Jersey, USA

Dr. Samadi is a unique person having reached the pinnacle of his profession, while at the same time treating all his patients with compassion as though they are members of his immediate family.