HIFU - (High Intensity Focussed Ultrasound)

Prostate carcinoma is one of the most common types of cancer in Western industrial nations with an incidence of 57/100,000 male inhabitants. Significantly larger numbers of men have been diagnosed with prostate carcinoma and treated because of improved diagnosis (prostate-specific antigen/PSA) in the last 2 decades. The higher diagnosis rate is, however, also associated with the increasing number of men who go to their urologist for yearly routine check-ups after the age of 45.
The suspicion of malignant disease of the prostate based on PSA-measurement and prostate examination must first be verified 100% by an ultrasound-guided prostate biopsy (see information sheet on core needle biopsy). If a prostate carcinoma (prostate cancer) is diagnosed, a wide range of different treatment methods is available to the patient. An individual decision will be taken and discussed with each and every patient who has a diagnosis of prostate cancer regarding the best therapy option for him based on the tumour stage, PSA-count, palpation diagnosis etc. 
In the case of a localised prostate carcinoma, the first therapy of choice is an open, radical prostatectomy with removal of the regional lymph glands. However, this therapy is traumatic for the patient and not all men can have this type of therapy.  While it can lead to a long-term cure of the prostate cancer in 80% of cases, it is on the other hand associated with loss of blood, possible loss of potency, a low risk of urinary incontinence, a longer stay in hospital and a reconvalescent phase. 
Further treatment methods for localised prostate-carcinomas are: external radiation or the implantation of radioactive pellets in the prostate (brachytherapy or seeds-implantation). Both methods can be seen as an alternative to the radical prostatectomy but long-term monitoring reveals somewhat worse tumour control. Erectile disorders appear somewhat belated.
Since 1996, the high intensity focussed ultrasound (HIFU) has been used as a less invasive treatment for prostate cancer. This method should directly eliminate or at least reduce the prostate carcinoma at its point of origin und thus keep it under control (see figs. n°1 and 2). Bleeding or serious urinary incontinence was seldom observed (<1%) in the over 11,200 treatments carried out with this method worldwide to date. When both prostate lobes are completely treated with this method, loss in potency is possible, as with the radical surgery, but is somewhat less probable (approx. 50%).
An advantage of the HIFU method is that it can be carried out under local anaesthetic which puts hardly any strain on the body; also it is bloodless. The duration of the treatment lies between 2 and 3 hours, depending on the size of the prostate. 
Patients stay in hospital for about 5 days after the procedure. Pain around the pelvis minor after the procedure is very slight. The heating effect of the HIFU treatment leads to a swelling of the prostate after the procedure and associated problems with urination. For this reason, a transurethral resection of the prostate (TUR-P) is performed and a suprapubic-catheter inserted for some days. 
The procedure is significantly less invasive and risky than surgery.
Serious complications during or immediately after HIFU treatment are rare.
Formation of a fistula, that is a connection between the intestine and urethra, was seldom all in all (1%). It has never as yet arisen in patients who had not previously been locally treated by surgery or radiation.
While no individual long-term guarantee of success is possible, there is in the meantime a store of medical experience with statistical evaluations over a time period of over 5½ years in different hospitals all over Europe. Depending on tumour stage, up to 93.4% of biopsies were tumour-free in biopsy controls. In a mid-term follow-up monitoring period of 22.2 months, the last measured PSA value was below 0.4 ng/mL for 73.7% of patients, pointing to good chances of a cure. Thus, as for all other therapies, the cure rate is not 100%.
If in follow-up period after-treatment, a suspicion of recurrence of the prostate cancer arises, treatment with HIFU (high intensity focussed ultrasound) – unlike other therapies – does not exclude any further treatment options: the treatment can be repeated, at least once. Furthermore, the above-mentioned alternatives, radiation of the prostate, hormone therapy and in exceptional cases surgery, can be considered. For a small number of patients, as expected, an additional therapy had to be introduced because of progression of the prostate cancer.