Your Treatment

What Can I Expect Before, During and After the Treatment?

Treatment Preparation

On the day prior to the procedure, you will be seen by the urologist, the anesthesiologist, and the nurse. All your information will have been reviewed in advance; however, you will have an opportunity to ask any final questions.

To prepare the lower bowel for the procedure you will be provided with an enema which is to be administered in the morning before coming to the hospital for treatment.

Treatment Procedure

Since it is necessary that all your movement be minimized during the treatment, spinal anesthesia is administered as well as intravenous sedation so you will rest comfortably during the procedure. The treatment may last anywhere from 2 to 3 hours depending on the size of your prostate. The treatment is performed with you lying on your right-hand side.

The urologist inserts a small probe into the rectum after coating it with gel and placing it inside a latex balloon filled with a cooling liquid. This maintains a constant temperature in the rectal wall during the entire treatment. The urologist locates the limits of the prostate by ultrasound examination and outlines the zone he wishes to treat. Then 400 to 600 pulses of high-intensity focused ultrasound are administered to the prostate. As a result of the treatment the prostate swells immediately and compresses the urethra. For this reason, a temporary catheter is inserted into the bladder to drain urine until the swelling of the prostate goes down. Generally, the catheter will be required to stay in place for 14 days.

If you have an enlarged prostate with symptoms or signs of prostatic obstruction (i.e. weak urinary stream, frequent urination at night, or sensation of residual urine volume in the bladder), you may need to have the prostate reduced prior to treatment. This is usually done by the use of medication (cyto-reduction) or by having part of your prostate resected prior to having the treatment. This procedure is called a transurethral resection of the prostate (TUR-P).

Immediate Post Treatment

As this is an ambulatory procedure, you will go to your hotel the same day and be able to resume a normal diet the same evening. The urinary catheter is generally removed 14 days after the treatment date. You will need to take antibiotics while you have the catheter in place to prevent the occurrence of a urinary infection. You will notice white particles passing in the urine which is the destroyed prostate tissue. You will also notice blood in the urine at approximately day 7. This is part of the normal healing process as more tissue continues to slough away. After the catheter is removed, you may experience some mild burning and bleeding when you start to void. Initially you may also experience more frequent and sometimes a more urgent need to void. During the healing process, you may experience some urine leakage on exertion or if you do not get to the toilet on a timely basis. A urinary tract infection with a fever is rare but possible. If a fever develops you should contact your physician immediately.

How Many Treatments Will I Require?

Peer reviewed Journal Articles from Europe report on patients treated as far back as 1995. Their re-treatment rate is approximately 10%. To date fewer than 3% of the patients treated in Toronto, Ontario, Canada have required re-treatment. Indication for re-treatment is if the PSA remains elevated after treatment or the PSA exceeds ASTRO targets after achieving nadir levels. The ASTRO criteria of failure is based upon the PSA value rising by more than 0.3 ng/ml in two successive 3 month periods or exceeding the nadir value by more than 2.0 ng/ml. If this occurs a repeat trans rectal ultrasound with biopsy would be required to determine if re-treatment is necessary. A negative bone scan and abdominal and pelvic Cat Scan would also be necessary. If a nerve sparing procedure is done, the re-treatment rate may be higher. One unique advantage of treatment with Ablatherm ® HIFU is the fact that re-treatment is possible if tumor persists or recurs locally.

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