Focal therapy using high-intensity focused ultrasound for localised prostate cancer

Evidence-based recommendations on focal therapy using high-intensity focused ultrasound for localised prostate cancer. This involves using high-intensity focused ultrasound to heat up and destroy only the areas of the prostate with cancer (focal therapy). The aim is to destroy the cancer while reducing damage to healthy prostate tissue.

# Recommendations
Evidence on the safety of focal therapy using high-intensity focused ultrasound for localised prostate cancer is adequate, but evidence on its efficacy is limited. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wanting to do high-intensity focused ultrasound for localised prostate cancer should:
Inform the clinical governance leads in their healthcare organisation.
Give people (and their families and carers, as appropriate) clear written information to support shared decision making, including NICE's information for the public. Use the recommendations in NICE's guideline on diagnosing and managing prostate cancer for information on treatment options and decision support.
Ensure that people (and their families and carers, as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
Patient selection should be done by a multidisciplinary team.
Further research could include registry data or randomised trials. It should include details of patient selection, including size and classification of tumour, technique used and long-term outcomes such as quality of life.# The condition, current treatments and procedure

# The condition
Prostate cancer can cause some lower urinary tract symptoms such as frequency, urgency, hesitancy, terminal dribbling and an overactive bladder. Localised prostate cancer is confined to the prostate and has not spread to nearby tissues or other parts of the body.

# Current treatments
NICE's guideline on prostate cancer describes how to diagnose and manage prostate cancer. Decisions on treatment are based on imaging, tumour staging, risk assessment and prostate-specific antigen (PSA) levels. For some people, localised prostate cancer grows slowly or not at all, and treatment may not be necessary. In such cases, watchful waiting or active surveillance strategies may be appropriate. If treatment is needed, several options are available. These include radical treatments (such as radical prostatectomy, external beam radiotherapy and radical brachytherapy), focal treatments (such as focal high-intensity focused ultrasound , focal cryoablation, irreversible electroporation, focal laser ablation and focal brachytherapy) and adjunctive treatments (such as chemotherapy and androgen deprivation therapy).

# The procedure
Imaging and biopsy mapping are used to confirm that the tumour is suitable for focal therapy and to show its precise location. With the person under spinal or general anaesthesia, the bladder is catheterised using a urethral or supra-pubic catheter and the HIFU probe is inserted transrectally. Ultrasound imaging guidance is used to position the probe and to monitor the procedure. Pulses of HIFU are directed at the targeted part of the prostate, inducing tumour necrosis by a thermal effect and causing cavitation (which can be visualised by ultrasound to assess the adequacy of treatment) until satisfactory ablation of the target area is judged to have occurred. This procedure differs from standard whole-gland HIFU in that only some of the prostate is treated. Transurethral resection of the prostate may be done at the same time as focal HIFU to reduce urinary symptoms.