HIFU focal therapy for prostate cancer
An outpatient treatment that uses focused ultrasound energy, aimed from a probe in the rectum, to heat and destroy the part of the prostate that contains cancer while leaving the rest of the gland alone.
Also called HIFU, High-intensity focused ultrasound, Focal HIFU, Focal therapy, Hemi-gland ablation, Partial gland ablation, Prostate ablation, Sonablate
- Where
- Hospital or outpatient surgery center
- Anesthesia
- General anesthesia, sometimes a spinal anesthetic
- Time in the room
- About 1 to 3 hours
- Hospital stay
- Same day for most
- Going home with
- Urinary catheter, through the penis or the lower belly, for about 3 to 7 days, sometimes longer
- Back to normal
- About 1 to 2 weeks
- Back to work
- About 1 week; some return to desk work sooner
Overview
HIFU stands for high-intensity focused ultrasound. Much like a magnifying glass focuses sunlight to a hot point, the HIFU probe focuses ultrasound waves onto a tiny spot inside the prostate. The tissue at that spot heats to a temperature high enough to destroy it within seconds, while tissue just outside the focus is spared.
In focal therapy, only the part of the prostate with significant cancer is treated, plus a margin of healthy tissue around it. Sometimes one whole half of the prostate is treated, called hemi-gland ablation. Because the urinary sphincter, much of the prostate, and usually the nerves on the untreated side are left alone, leakage and erection problems are less common than after surgery or radiation of the whole gland in most studies.
The trade-off is certainty. Prostate cancer is often found in more than one spot, and the untreated parts of the gland can develop cancer later. Men need regular PSA tests, MRI scans and follow-up biopsies, and some need a second treatment. Surgery and radiation remain possible later, though surgery after HIFU can be more difficult.
In the U.S., HIFU devices are FDA-cleared to destroy prostate tissue. Major guidelines describe focal therapy as a reasonable option for carefully selected men, best done in experienced centers with close follow-up or within a study. It is not a standard choice for widespread or high-risk cancer, and guidelines advise against it for most low-risk cancers, which are better watched.
The parts of your body involved
The prostate sits just in front of the rectum, which is why a probe in the rectum can both see it and aim energy into it. The urethra runs through the middle of the prostate, the urinary sphincter sits just below it, and the erection nerves run along its sides. Focal therapy aims to destroy the cancer while keeping these structures safe.
- Prostate
A walnut-sized gland under the bladder. In focal therapy, only the part containing the cancer is treated.
- The cancer target
The area of cancer seen on MRI and confirmed by targeted biopsy. Ideally it is a single area of limited size.
- Rectum
The bowel just behind the prostate. The HIFU probe sits here, and its wall is cooled and protected during treatment.
- Urinary sphincter
The muscle below the prostate that keeps you dry. It is kept outside the treatment zone.
- Erection nerves
Thin nerve bundles along the sides of the prostate. On the untreated side they are usually unaffected.
Why it’s done
Focal therapy is meant for men whose cancer needs treatment but sits in one limited area, and who want to keep urinary and sexual function as close to normal as possible while accepting closer follow-up.
- Treating a cancer that needs treatment
For a single area of intermediate-risk cancer, HIFU aims to destroy it before it grows or spreads.
- Fewer side effects
Sparing most of the prostate, the sphincter and usually one or both nerve bundles keeps urinary control and erections closer to how they were for most men.
- A short recovery
There is no incision. Most men go home the same day and return to normal activities in 1 to 2 weeks.
- Options stay open
If cancer appears later, repeat HIFU, surgery or radiation remain possible.
- Cancer after radiation
In selected men whose cancer comes back only in the prostate after radiation, HIFU is one of the salvage options, though side effects are more common in this setting.
Other options
- Active surveillance
Watching the cancer with PSA tests, MRI and biopsies. Preferred for most low-risk cancers and an option for some favorable intermediate-risk cancers.
- Robotic radical prostatectomy
Removing the whole prostate. More certain long-term cancer control, with higher chances of leakage and erection problems.
- External beam radiation
Radiation to the whole prostate from outside the body over 1 to 9 weeks, sometimes with hormone therapy.
- Seed implant (brachytherapy)
Radioactive seeds placed in the whole prostate in one outpatient procedure.
- Focal cryoablation
Destroying the cancer area by freezing it with needles placed through the skin between the scrotum and anus.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The day before
The morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
You are put to sleep with general anesthesia, or sometimes given a spinal anesthetic. Depending on the device, you lie on your back with your legs in padded supports, or on your side. You need to stay completely still during treatment, which is one reason anesthesia is used.
After the operation
Right afterward
- Waking up
You wake in the recovery room with a catheter. Discomfort is usually mild.
- Medicines
You may go home with an anti-inflammatory or pain medicine, a medicine to relax the prostate, a short course of antibiotics, and something for bladder spasms.
- Catheter teaching
A nurse shows you how to use the leg bag and night bag.
- Going home
Most men go home the same day. Someone must drive you.
At home
- Pain
Mild aching in the rectum or between the legs is common for a few days. Acetaminophen usually helps.
- Catheter care
Keep the bag below your bladder, wash the tip of the penis daily, and use a little lubricant where the tube enters.
- Urine changes
After the catheter is out, burning, frequent urination and urgency are common for several weeks. Some men pass small bits of dead tissue or debris in the urine, usually 2 to 8 weeks after treatment.
- Fluids and bowels
Drink plenty of fluids to keep urine pale. Avoid constipation and straining.
- Activity
Walk as you like. Avoid heavy lifting, hard exercise and bicycle riding for about 2 weeks.
- Sex
Wait until the catheter is out and you feel comfortable, often about 2 to 4 weeks. Semen volume is often reduced, and some men become dry.
- Driving and work
Most men drive once the catheter is out and they are off strong pain medicine. Desk work is often possible within about a week.
Recovery timeline
- Day 0Treatment day
Treatment takes about 1 to 3 hours. Most men go home the same day with a catheter.
- Days 3 to 7Catheter out
The catheter is removed in clinic. Expect some burning and frequent urination.
- Weeks 2 to 8Healing
The treated tissue is slowly absorbed. Urinary irritation settles, and you may pass small bits of debris.
- Weeks 4 to 6Back to normal
Most men are back to normal activity and sexual function is recovering.
- 3 monthsFirst PSA
PSA falls but does not go to zero, because untreated prostate tissue still makes PSA. The lowest value becomes your new baseline.
- 6 to 12 monthsFollow-up MRI and biopsy
An MRI checks the treated area, and most programs advise a biopsy about a year after treatment.
- Long termOngoing follow-up
PSA tests every few months and regular MRI scans continue for years. If cancer is found, repeat focal treatment or whole-gland treatment can be considered.
What it feels like
Most men describe HIFU as much easier to recover from than they feared. The hardest parts are the catheter for a few days, the urinary irritation that follows, and living with the knowledge that follow-up checks matter.
Deciding
Choosing a newer treatment can feel uncertain. Many men worry whether they are trading cancer control for fewer side effects.
What helpsAsk about your center's own results, how many treatments they have done, and exactly what the follow-up plan is. A second opinion from a surgeon or radiation oncologist can help you feel sure.
Waking up
Usually little pain, some rectal soreness, and the odd feeling of the catheter.
What helpsTell the nurse about any pain or bladder cramps. Ice chips and short walks help.
The catheter days
The catheter is awkward, and bladder spasms with urine leaking around it can be startling.
What helpsKeep the tube strapped to your thigh, use lubricant at the tip, and take the spasm medicine if prescribed.
After the catheter comes out
Burning, needing to go often and urgently, and sometimes passing flecks of tissue. It can feel worse before it gets better.
What helpsDrink plenty of water, limit caffeine, alcohol and spicy foods, and take the prescribed medicines. Call if you cannot pass urine.
Sex and ejaculation
Erections often return within weeks, but less semen, or none, can feel strange.
What helpsAsk your team what to expect for your size of treatment zone. Erection pills can help in the early weeks.
Follow-up tests
Because PSA does not go to zero, every result can bring worry. The follow-up biopsy can feel like starting over.
What helpsAsk your team ahead of time what PSA level and pattern they expect for you. Knowing the plan makes each number easier to read.
How well it works
Success means no significant cancer is found in the treated area on follow-up MRI and biopsy, with urinary control and erections kept close to how they were before.
- PSA
PSA drops to a new low point within a few months but stays above zero. A steady rise from that low point may lead to an MRI or biopsy.
- MRI
An MRI about 6 to 12 months after treatment checks for any remaining or new cancer.
- Follow-up biopsy
Many programs recommend a biopsy of the treated area and the rest of the prostate about a year after treatment.
- Retreatment
In large series, some men need a second focal treatment, and a smaller number go on to surgery or radiation. Long-term results beyond 5 to 10 years are still being collected.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Burning, frequent urination and urgency for several weeks after the catheter comes out.
Usually mild and short-lived.
Semen volume often drops, and some men become dry, especially with larger treatment zones.
Small bits of treated tissue can pass in the urine during healing.
Erections are often weaker for a few weeks to months, then improve for most men.
Less common
Swelling or debris can block urine after the catheter is removed and may need the catheter put back for a few days.
Infection of the urine or the epididymis (the coiled tube behind the testicle) is uncommon and treated with antibiotics.
Scar tissue can narrow the urethra or bladder neck, causing a weak stream. It may need a short scope procedure. It is more likely with larger treatments.
Some men have lasting erection problems, more often after hemi-gland or whole-gland treatment than after small focal treatment.
Lasting leakage is uncommon after focal treatment but more likely after treatment following radiation.
Rare
Heat damage can rarely create an abnormal channel between the urethra and the rectum, which needs surgery to repair. The cooling balloon and safety limits are designed to prevent this.
Pressure injuries from positioning are rare.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills.
- No urine draining from the catheter for 1 to 2 hours with lower belly pain, or after the catheter is out, you cannot pass urine.
- Heavy bleeding or clots in the urine.
- Gas, stool or bubbles coming out in the urine, or urine coming from the rectum.
- Severe or worsening pain in the rectum, between the legs, or in the lower belly.
- A painful, swollen testicle.
- Swelling or pain in one calf, or sudden shortness of breath (call 911).
Questions to ask your surgeon
- Is my cancer a good fit for focal therapy, and why?
- Will you treat a small area, half the prostate, or the whole gland?
- How many HIFU treatments has your team done, and what are your results?
- What are my chances of needing another treatment later?
- How long will I have a catheter?
- What is my follow-up plan for PSA, MRI and biopsy?
- What are the chances of leakage and erection problems for my treatment zone?
- If cancer comes back, could I still have surgery or radiation?
- Is this covered by my insurance?
Words you may hear
- HIFU
- High-intensity focused ultrasound: sound waves focused to a tiny point to heat and destroy tissue.
- Focal therapy
- Treating only the part of the prostate that contains significant cancer.
- Hemi-gland ablation
- Treating one whole half of the prostate.
- Ablation
- Destroying tissue in place, with heat, cold or another energy, without removing it.
- Treatment margin
- The rim of healthy tissue treated around the cancer to make sure its edges are covered.
- Fusion
- Software that overlays MRI images on the live ultrasound.
- PSA nadir
- The lowest PSA value reached after treatment.
- Fistula
- An abnormal channel between two organs, such as the urethra and rectum.
- Salvage treatment
- Treatment given when cancer comes back after a first treatment.
Common questions
Is HIFU as good as surgery or radiation?
For carefully selected men, medium-term results are encouraging, with fewer side effects. Long-term cancer control is less certain than with surgery or radiation, and some men need more treatment later, which is why close follow-up is essential.
Does it hurt?
You are asleep during treatment. Afterward, most men have mild soreness and urinary irritation rather than significant pain.
Will my PSA go to zero?
No. The untreated part of the prostate still makes PSA. Your team watches for a steady rise from your new lowest value.
Can HIFU be repeated?
Yes. If cancer is found later in the same or another area, a second HIFU treatment is often possible.
Can I still have surgery later if I need it?
Yes, though scarring from HIFU can make surgery more challenging. Ask how often your team or local surgeons have done this.
Will I still ejaculate?
Many men do, with less volume. Some, especially with larger treatment zones, become dry.
Sources this page draws on
- American Urological Association and American Society for Radiation Oncology, Clinically Localized Prostate Cancer: AUA/ASTRO Guideline (2022)
- European Association of Urology, EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer
- European Urology, A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer (Guillaumier and colleagues, focal HIFU) (2018)
- The Lancet Oncology, Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study (2012)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.