High-intensity focused ultrasound (HIFU) for prostate cancer

High-intensity focused ultrasound (HIFU) uses sound waves to heat and destroy small areas of prostate cancer. It is a type of focal treatment, which means it targets only the parts of the prostate with cancer. HIFU is suitable for men whose cancer has not spread beyond prostate. This is called localised prostate cancer. 

During the procedure, an ultrasound device is placed in the rectum. It sends sound waves through the wall of the rectum into the prostate. These sound waves heat and destroy the cancer with great accuracy, leaving the healthy tissue around it unharmed. If some areas of your prostate have very slow-growing cancer, we may not treat them right away. Instead, we watch these areas closely and treat them only if the cancer grows or changes.

© Cancer Research UK [2002] All rights reserved. Information taken 04/02/2025 

HIFU is done under general anaesthetic, so you will be asleep and will not feel any pain. It is a day-case treatment, meaning you can usually go home the same day.  

The treatment is minimally invasive, with no cuts or needles. It has fewer risks than traditional treatments, such as surgery or radiotherapy. The aim is to treat the cancer in the prostate while avoiding nearby nerves and muscles that control erections and urine flow. 

At our centre, we have successfully treated over 1,000 men with HIFU.

Here are the benefits of HIFU: 

• It may cure the cancer. 
• It is minimally invasive, with no cuts or stitches. 
• Most patients go home on the same day as their treatment. 
• Recovery is quick, so you can get back to your usual activities sooner. 
• It has fewer side effects because it targets only the tumour and not the entire prostate.

All treatments have risks. Below are some possible risks of HIFU. We will discuss these and any risks specific to you in detail.    

• Erections: HIFU targets only the cancer, so most men with good erections before treatment will keep natural erections. About 30 in 100 men may need medication to help.  
• Need for further treatment: After five years, about 25 in 100 men may need another HIFU session. About 7 in 100 may need surgery or radiotherapy.  
• Urine leakage (incontinence): This happens in less than 1 in 100 men and often improves with time. We can teach you pelvic floor exercises to help. 
• Urethral tissue sloughing: About 1 in 100 men may have tissue shedding in the urethra, the tube that carries urine from the bladder to the tip of the penis. This can cause pain or difficulty peeing. Rarely, surgery is needed to clear the tissue and improve urine flow. 
• Fistula risk: There is a 1 in 1000 chance of developing a fistula (a hole between the bladder and bowel). Very rarely, bowel surgery may be needed. 

There are also some risks linked to having general anaesthetic. You can visit the Royal College of Anaesthetists website for more information. Your doctor or CNS will explain these risks in detail and answer any questions you may have.

Most men with prostate cancer have different treatment options to choose from. Your healthcare team will explain these options, and you may see several specialists. You can also find more details on our treating prostate cancer web page. 

There is no single ‘best’ treatment for localised prostate cancer. Each option has its own benefits, risks and side effects. Treatments affect men differently, so it’s important to think about how you would manage the side effects and how they might impact your daily life. Your healthcare team will guide and support you in choosing the treatment that best fits your needs and lifestyle.

This depends on whether your prostate cancer is low-risk or high-risk. Your hospital doctor will have already explained which group you are in. If you are unsure or have any questions, speak to your doctor or CNS.  

• High-risk prostate cancer: You will likely need treatment. Without it, the cancer may grow and spread. Waiting too long could make treatment harder or even impossible. This could put your life at risk.
• Low to medium-risk prostate cancer: You may not need treatment right away. Instead, we can monitor it with active surveillance for 5 to 10 years. This means having regular tests to check on the cancer. If there are signs that your cancer is progressing, we will offer you treatment.  
  • At UCLH, one in three men with low to medium-risk cancer needed treatment after 5 years. Some men choose treatment right away because they feel uneasy waiting. However, studies show that survival rates are very similar whether you have treatment now or later.   
  • Note: If your cancer is very low-risk and doesn’t show on an MRI scan, treatment may not be an option.

Pre-assessment appointment

A few weeks before your HIFU treatment, you will have an appointment with a nurse at the pre-assessment clinic. The nurse will check if you are well enough for the treatment and will: 

• Explain the anaesthetic you will have. 
• Tell you if you should continue taking your medicines. 
• Let you know when to stop eating and drinking. 
• Advise what to bring on the day. 

Planning for travel home

Arrange for someone to take you home and stay with you overnight. If you don’t have someone, you will need to stay in the hospital overnight. It’s ok to use public transport if you need to. 

Arranging to have your catheter removed

You will have a urinary catheter (tube) placed in your bladder during HIFU to drain urine. This will stay in place for three to seven days.  

We prefer you to have your catheter removed at UCLH. But if you’d like it done closer to where you live, contact your GP surgery to arrange this before your treatment. This is because some local services may not offer the catheter removal. If you haven’t arranged it before your treatment, you will have your catheter removed at UCLH.

We want to involve you in decisions about your care and treatment. If you decide to go ahead with prostate HIFU treatment, we will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.  

Before you sign, your doctor or CNS will explain the risks, benefits and alternatives. If you are unsure about anything, ask them for more information.

• On the morning of your treatment, a nurse will give you an enema to clear your rectum. This will help to provide clearer ultrasound images. 
• You will have your HIFU treatment one to two hours after the enema. 
• An anaesthetist, a doctor who provides anaesthesia and manages pain, will give you a general anaesthetic to put you into a deep sleep. This makes sure you cannot feel anything. It also helps you to stay still so the treatment can be done with accuracy. 
• Once you are asleep, the surgeon will place a urinary catheter (a tube) in your bladder to drain urine.  
  • Most often, this is a urethral catheter inserted through the penis.  
  • Sometimes, we may need to use a suprapubic catheter instead. This is inserted directly into the bladder through the lower abdomen (tummy). 
• The surgeon will place the HIFU probe into your rectum. This probe sends ultrasound waves to your prostate through the rectum. The treatment usually takes one to two hours. 
• You will have an anticoagulant injection to help prevent blood clots. Anticoagulants are also sometimes called ‘blood-thinning’ medicines.  
• Once the treatment is finished, your anaesthetist will wake you up.  
• Most men can go home three to four hours later, as long as they have someone to travel with them and stay overnight.   
• If your healthcare team think you need to stay in the hospital overnight for monitoring after HIFU, they will let you know.

• You will stay in the day surgery unit until you are fully awake and have eaten and drunk something. You may feel some discomfort in your rectum and penis. Mild painkillers like paracetamol or ibuprofen usually help. Tell your nurse if you are still in pain, they can give you stronger painkillers like codeine.
• You may also be given tablets to relax your prostate. These are called alpha-blockers, such as tamsulosin or alfuzosin.
• Before you go home:

1. We will show you how to empty and care for your catheter. We will give you a spare day bag, night bag and valve for your catheter. 
2. We will give you antibiotics to take for three to five days to prevent infection. 
3. We will give you a contact number in case you have any problems at home. 
4. Ask for a fit note (sick note) if you need one. You may need the fit note to cover you for one to two weeks off work. This may be longer, depending on your job. 
5. We will make an appointment for catheter removal.  

Please note: 

If you had another treatment before HIFU, such as radiotherapy, it might take longer for your urine flow to return to normal. Your doctor and CNS will talk to you about this before your treatment.

• You may find it difficult to pass urine. The catheter inserted during the procedure will help with this. It will stay in place for three to seven days.   
• You may notice swelling of your penis or scrotum in the first or second week after HIFU. This usually gets better within two months. 
• You may notice tingling or numbness around the penis. This usually gets better within two to four months.  
• You may notice blood in your pee, semen or from your bottom. This will settle down within six to eight weeks.

Most people feel better within one to two weeks.

• It’s normal to feel tired for a few days due to the anaesthetic.
• You may be able to return to work once the catheter is removed, depending on your job.

Take time to rest and recover.

First 24 hours:  

Let your pee drain freely into the catheter bag (leg bag). At night, you can attach a larger night bag. 

After 24 to 48 hours:  

You no longer need to let your pee drain freely into the bag. Instead, you can let it collect in your bladder. To do this, detach the leg bag from the catheter and attach a catheter valve. If the valve is already fitted, remove the leg bag from the valve. 

When the valve is off (up position), your bladder will fill with urine. When you feel the need to pee, open the valve to empty the urine into the toilet. Close the valve again once you have emptied your bladder.

Caring for your catheter

You can find detailed instructions on our Caring for your urinary catheter web page. If you’d like a paper copy of the information, ask your ward nurse or CNS. 

If your catheter blocks, falls out, or you have another issue with it, go to your local Emergency Department (A&E). Please take your discharge summary with you and show it to the doctor treating you. 

Tips for draining urine

Emptying the bladder through the catheter valve can cause the bladder to collapse onto the catheter, which can be painful. To avoid this:  

• Open the valve slowly and let urine drain gently.
• Stop draining when you feel the bladder is empty.
• Close the valve before it becomes uncomfortable.

Having your catheter removed

You will have a ‘trial without catheter’ (TWOC) appointment at UCLH to have your catheter removed. This will take place three to seven days after your treatment. We will check your bladder once we remove the catheter to make sure it empties properly. This appointment will take three to four hours. 

If you prefer to have the catheter removed nearer to where you live, contact your GP surgery to arrange this. It’s important that you contact your GP before your HIFU treatment. This is because some local services may not offer the catheter removal. If you haven’t arranged to have the catheter removed before you have your treatment, you will have an appointment in the TWOC clinic at UCLH.

Regular monitoring by your GP and hospital team is essential after HIFU treatment. While many men may be cured, some may need further treatments.  

You will have a follow-up appointment at UCLH three months after your treatment. It is very important that you have your first PSA test done just before this appointment. 

PSA blood tests

Your PSA levels will be checked regularly to monitor your recovery. We expect your PSA levels to go down after HIFU treatment. The amount of reduction can vary for each person.  

• First PSA test: 3 months after HIFU.
• First year: Every 3 months.
• After 1 year: If stable, every 6 months.

We will give you a PSA level to watch for. If your PSA goes above this level, contact us so we can review your care. We will ask you to provide a urine sample through your GP to check for infection. We’ll then ask you to repeat the PSA test six weeks later. We will not make a decision on your care based on a single result.  

You will have yearly telephone appointments with your hospital doctor or CNS to discuss your PSA results. 

MRI scans

You may have an MRI scan 10 to 14 days after treatment to check for any issues from HIFU. The surgeon will tell you on the day if you need one.

Please note: There is no routine appointment to discuss the results. Your doctor will go over them with you at your follow-up appointment three months after HIFU. 

All patients have MRI scans at:  

• 1 year after treatment.
• 3 years after treatment.
• 5 years after treatment.

You will have an appointment to discuss the results of these scans. 

Other monitoring

We will monitor you for any urine or erection problems, and offer you support or treatment as needed. If you have trouble with your erections or urine symptoms, contact your doctor or CNS for help.

After HIFU, some men may need additional treatment if the cancer returns. 

• If your PSA level continues to rise, you may have an MRI scan and prostate biopsies to check for cancer.  
• If cancer is found, you may have the HIFU treatment again. About 1 in 4 men need a repeat HIFU within 5 years.  

If another HIFU isn’t suitable, your surgeon may recommend: 

• Surgery
• Radiotherapy
• Cryotherapy
• Hormone therapy.

Each treatment has different side effects and success rates. Your doctor will explain these options to help you decide on the best treatment for you.

Prostate cancer treatments choices  

A video developed by North Central and East London Cancer Alliance to help you learn about prostate cancer treatments. 

UCLH Macmillan Support and Information Service 

020 3447 8663 (general enquiries) 

020 3447 3816 (support and information helpline) 

They provide: 

• Emotional support, advice and information 
• Welfare and benefits advice 
• Complementary therapies 
• Diet and nutritional advice 
• Psychological and emotional care 
• UCLH Prostate Cancer Support Group, which is held on the 2nd Thursday of each month, from 12.30pm to 2.30pm. You can attend either online or in person. Email uclh.supportandinformation@nhs.net for more information. 

Prostate Cancer UK      

Tel: 0800 074 8383    

Macmillan Cancer Support

Tel:  0808 808 00 00 

Cancer Research UK 

Infopool by Prostate Cancer Research

The prostate resource co-designed with healthcare professionals and patients.  

Squeezy app 

Support with pelvic floor muscles. Includes exercise videos. 

Your Pelvic Floor  

Provides information on pelvic floor exercises. 

5K Your Way – Move Against Cancer  

This program invites anyone affected by cancer – patients, family members and cancer care workers – to take part in a 5K Your Way parkrun. Whether you want to walk, jog, run, cheer, or volunteer, you’re welcome to join on the last Saturday of each month. 

University College London Hospitals NHS Foundation Trust cannot accept responsibility for information provided by external organisations.

Prostate Clinical Nurse Specialists (CNSs) (Mon – Fri, 9am to 5pm) 

Tel: 07984 391126 

Email: Uclh.prostatecancercns@nhs.net 

Pathway Coordinator for admin queries (for example changing your appointment) (Mon – Fri, 9am to 5pm) 

Tel: 020 3447 9194 

Email: Uclh.prostate.focal@nhs.net 

Out of hours, please contact your GP or go to your nearest Emergency Department (A&E).