In this guide
TECHNOLOGY, EXPLAINED VISUALLY
Equipment & illustrations
Enlarge ↗Focal One
An image-guided HIFU system that focuses ultrasound energy on selected prostate tissue. Suitability depends on cancer location, extent and individual assessment.
Image: Focal One / EDAP TMS ↗
Focused ultrasound, precisely planned.
High-intensity focused ultrasound (HIFU) concentrates ultrasound energy to heat and destroy targeted prostate tissue. Focal One is a platform used to deliver HIFU.
Focal treatment aims to treat the area containing significant cancer while leaving some prostate tissue untreated. It differs from removing the whole prostate or treating the whole gland with radiation.
Who might be considered?
Disease that can be mapped
Imaging and biopsy must establish where clinically important cancer is located. An MRI finding alone is insufficient.
An appropriate risk profile
Selected localised cancers may be considered after comparison with surveillance, surgery and radiation.
A commitment to follow-up
Untreated prostate remains. Repeat imaging and biopsy, and the possibility of more treatment, must be acceptable.
Lesion position, disease outside the intended treatment area, prostate anatomy and technical factors can affect feasibility. A specialist must review the actual images and pathology.
A balanced discussion before treatment.
Focal therapy seeks to limit damage to surrounding structures, but it does not guarantee preservation of urinary or sexual function. Temporary urinary symptoms, retention, infection and erectile problems may occur; rare serious complications are possible.
Long-term comparative evidence is less mature than for established whole-gland treatments. EAU guidance places focal HIFU or cryotherapy within prospective registries. Ask how evidence collection and follow-up are organised.
Further reading: EAU: focal therapy guidance · American Cancer Society: ablative treatments
Treatment is the start of follow-up.
- Agree on a surveillance planObtain a written plan covering PSA, clinical review, MRI and repeat biopsy.
- Interpret PSA in contextBecause prostate tissue remains, PSA is not expected to behave as it does after complete prostate removal.
- Check treated and untreated areasFollow-up assesses both treatment response and disease elsewhere in the gland.
- Plan for additional care if neededResidual or recurrent disease may require repeat treatment, surgery, radiation or another strategy.
Is focal HIFU the same as active surveillance?
No. HIFU destroys tissue. Active surveillance monitors selected cancer and reserves treatment for changes that justify it.
Can HIFU replace surgery for every patient?
No. Cancer distribution, risk and anatomy can make it inappropriate. Discuss established alternatives before choosing focal therapy.
Can I stop follow-up if I feel well?
No. Feeling well does not establish cancer control. Keep the agreed imaging, PSA and biopsy appointments.