FDA Approved square

Focused ultrasound treatment for the prostate is available in the United States.

Three focused ultrasound systems for destroying diseased prostate tissue are approved by the Food and Drug Administration. In addition, Medicare has taken steps to cover this treatment, which will hopefully impact the commercial carriers to do the same.

Focused Ultrasound Therapy

Focused ultrasound is a noninvasive, radiation-free method to destroy prostate tissue and treat prostate disease. Using real-time image guidance, the physician directs a focused beam of ultrasound energy to a selected volume in the patient’s prostate gland.

How it Works
Outside Approval SquareFocused ultrasound energy heats and destroys the targeted tissue at the focal point within seconds. This process is repeated until the entire selected volume or the entire gland is destroyed.

Advantages
The primary options for treatment of prostate cancer include invasive procedures that may include ionizing radiation and surgery.

For certain patients, focused ultrasound could provide a noninvasive, radiation-free alternative to surgery with less risk of complications and lower cost. It is a low-morbidity treatment that usually only requires a single therapy session and has a short recovery time. It is reported to have a low complication rate, especially when considering post-procedure impotence and incontinence. Focused ultrasound treatment does not use ionizing radiation, and it is possible to offer it as a salvage therapy for patients who fail radiation treatment. Focused ultrasound treatment can be a complement to drug therapy, enabling enhanced delivery of chemotherapy or immunotherapy to tumors, and it may potentially induce an anti-tumor immune response.

Clinical Trials SquareClinical Trials

There are numerous clinical trials worldwide using focused ultrasound to treat prostate cancer.

See a full list of prostate cancer clinical trials > 

See a list of treatment sites >
See a list of clinical trials sites >
See a list of laboratory research sites >

Regulatory Approval and Reimbursement

Focused ultrasound devices have been cleared to treat the prostate in approximately 50 countries, including the United States. Several systems for focused ultrasound ablation of prostate tissue are available in various geographical regions, each differing in their guidance method (ultrasound vs. magnetic resonance imaging) and approach – transrectal or transurethral. Find a center near you >

There are three focused ultrasound manufacturers that are approved in the US for the ablation (destruction) of prostate tissue – SonaCare Medical,  EDAP-TMS, and Profound Medical. Some of these systems deliver care outside of the MRI facility, so they are found in surgery centers and surgical suites, as well as in hospitals. 

While the Foundation attempts to keep the list of sites complete, there have been many purchases of the focused ultrasound systems. For the latest information on availability, we recommend contacting the manufacturers’ directly or using their online search functions. 

There are additional sites that use mobile focused ultrasound equipment. These sites may not be listed on the EDAP, SonaCare, or Profound Medical sites, and the best way to find them is to contact local urologists to see if they have focused ultrasound capability.

Reimbursement for primary treatment in the US has been lagging, and Medicare and most insurance companies are either covering a portion of the expense or not covering it at all. In the specific instance of salvage therapy after failed radiation, some Medicare providers and commercial insurance carriers are covering focused ultrasound use in this setting. As always, it is best to check with your specific carrier.

Notable Papers

Lomas DJ, Woodrum DA, Mynderse LA. Salvage ablation for locally recurrent prostate cancer. Curr Opin Urol. 2021 May 1;31(3):188-193. doi: 10.1097/MOU.0000000000000861.

Afshar-Oromieh A, da Cunha ML, Wagner J, Haberkorn U, Debus N, Weber W, Eiber M, Holland-Letz T, Rauscher I. Performance of [68Ga]Ga-PSMA-11 PET/CT in patients with recurrent prostate cancer after prostatectomy-a multi-centre evaluation of 2533 patients. Eur J Nucl Med Mol Imaging. 2021 Feb 4. doi: 10.1007/s00259-021-05189-3.

Giannakou M, Drakos T, Menikou G, Evripidou N, Filippou A, Spanoudes K, Ioannou L, Damianou C. Magnetic resonance image-guided focused ultrasound robotic system for transrectal prostate cancer therapy. Int J Med Robot. 2021 Feb 2. doi: 10.1002/rcs.2237.

Ghai S, Finelli A, Corr K, Chan R, Jokhu S, Li X, McCluskey S, Konukhova A, Hlasny E, van der Kwast TH, Incze PF, Zlotta AR, Hamilton RJ, Haider MA, Kucharczyk W, Perlis N. MRI-guided Focused Ultrasound Ablation for Localized Intermediate-Risk Prostate Cancer: Early Results of a Phase II Trial. Radiology. 2021 Mar;298(3):695-703. doi: 10.1148/radiol.2021202717. Epub 2021 Feb 2.

Shah TT, Reddy D, Peters M, Ball D, Kim NH, Gomez EG, Miah S, Evans DE, Guillaumier S, van Rossum PSN, Van Son MJ, Hosking-Jervis F, Dudderidge T, Hindley R, Emara A, McCracken S, Greene D, Nigam R, McCartan N, Valerio M, Minhas S, Afzal N, Lewi H, Ogden C, Persad R, Virdi J, Moore CM, Arya M, Emberton M, Ahmed HU, Winkler M. Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study. Prostate Cancer Prostatic Dis. 2021 Jan 28. doi: 10.1038/s41391-020-00315-y.

Hanada I, Shoji S, Takeda K, Uchida T, Yuzuriha S, Kuroda S, Ogawa T, Higure T, Nakano M, Kawakami M, Nitta M, Hasegawa M, Kawamura Y, Miyajima A. Significant impact of the anterior transition zone portion treatment on urinary function after focal therapy with high-intensity focused ultrasound for prostate cancer. J Endourol. 2021 Jan 26. doi: 10.1089/end.2020.0872.

Bründl J, Osberghaus V, Zeman F, Breyer J, Ganzer R, Blana A, Gierth M, Denzinger S, Burger M, Rosenhammer B. Oncological Long-term Outcome After Whole-gland High-intensity Focused Ultrasound for Prostate Cancer-21-yr Follow-up. Eur Urol Focus. 2021 Jan 19:S2405-4569(20)30318-7. doi: 10.1016/j.euf.2020.12.016.

Bates AS, Ayers J, Kostakopoulos N, Lumsden T, Schoots IG, Willemse PM, Yuan Y, van den Bergh RCN, Grummet JP, van der Poel HG, Rouvière O, Moris L, Cumberbatch MG, Lardas M, Liew M, Van den Broeck T, Gandaglia G, Fossati N, Briers E, De Santis M, Fanti S, Gillessen S, Oprea-Lager DE, Ploussard G, Henry AM, Tilki D, van der Kwast TH, Wiegel T, N'Dow J, Mason MD, Cornford P, Mottet N, Lam TBL. A Systematic Review of Focal Ablative Therapy for Clinically Localised Prostate Cancer in Comparison with Standard Management Options: Limitations of the Available Evidence and Recommendations for Clinical Practice and Further Research. Eur Urol Oncol. 2021 Jan 8:S2588-9311(20)30216-9. doi: 10.1016/j.euo.2020.12.008.

Hong SK, Lee H. Focused ultrasound and prostate cancer. Ultrasonography. 2020 Sep 1. doi: 10.14366/usg.20100.

Borges RC, Tourinho-Barbosa RR, Glina S, Macek P, Mombet A, Sanchez-Salas R, Cathelineau X. Impact of Focal Versus Whole Gland Ablation for Prostate Cancer on Sexual Function and Urinary Continence. J Urol. 2020 Aug17:101097JU0000000000001327. doi: 10.1097/JU.0000000000001327.

Norris JM, Carmona Echeverria LM, Simpson BS, Ball R, Freeman A, Kelly D, Kirkham A, Whitaker HC, Emberton M. Histopathological features of prostate cancer conspicuity on multiparametric MRI: protocol for a systematic review and meta-analysis. BMJ Open. 2020 Oct 22;10(10):e039735. doi: 10.1136/bmjopen-2020-039735.

de Almeida RVS, Silvino JRC, Kalil JR, Dos Santos VL Jr, de Souza VMG, Pontes J Jr, Guglielmetti GB, Sanchez-Salas RE, Claro JFA, Murta CB. Early Effects of High-intensity Focused Ultrasound (HIFU) Treatment for Prostate Cancer on Fecal Continence and Anorectal Physiology. Urology. 2020 Oct 17:S0090-4295(20)31265-6. doi: 10.1016/j.urology.2020.10.009.

He Y, Tan P, He M, Hu L, Ai J, Yang L, Wei Q. The primary treatment of prostate cancer with high-intensity focused ultrasound: A systematic review and meta-analysis. Medicine (Baltimore). 2020 Oct 9;99(41):e22610. doi: 10.1097/MD.0000000000022610.

Nair SM, Warner A, Lavi A, Rodrigues G, Chin J. Does adding local salvage ablation therapy provide survival advantage for patients with locally recurrent prostate cancer following radiotherapy? Whole gland salvage ablation post-radiation failure in prostate cancer. Can Urol Assoc J. 2020 Sep 28. doi: 10.5489/cuaj.6676.

Fallara G, Capogrosso P, Maggio P, Taborelli A, Montorsi F, Dehò F, Salonia A. Erectile function after focal therapy for localized prostate cancer: a systematic review. Int J Impot Res. 2020 Sep 30. doi: 10.1038/s41443-020-00357-9.

Abreu AL, Peretsman S, Iwata A, Shakir A, Iwata T, Brooks J, Tafuri A, Ashrafi A, Park D, Cacciamani GE, Kaneko M, Duddalwar V, Aron M, Palmer S, Gill IS. High Intensity Focused Ultrasound Hemigland Ablation for Prostate Cancer: Initial Outcomes of a United States Series. J Urol. 2020 Oct;204(4):741-747. doi: 10.1097/JU.0000000000001126. Epub 2020 Sep 8.

Sivaraman A, Marra G, Stabile A, Mombet A, Macek P, Lanz C, Cathala N, Moschini M, Carneiro A, Sanchez-Salas R, Cathelineau X. Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center. Int Braz J Urol. 2020 Nov-Dec;46(6):984-992. doi: 10.1590/S1677-5538.IBJU.2019.0682.

Nair SM, Peters M, Kurver P, Lavi A, Verhoeff JJC, van der Voort van Zyp JRN, van Son MJ, Chin JL. Long-term outcomes of two ablation techniques for treatment of radio-recurrent prostate cancer. Prostate Cancer Prostatic Dis. 2020 Aug 19. doi: 10.1038/s41391-020-00265-5.

Houédé N, Rébillard X, Bouvet S, Kabani S, Fabbro-Peray P, Trétarre B, Ménégaux F. Impact on quality of life 3 years after diagnosis of prostate cancer patients below 75 at diagnosis: an observational case-control study. BMC Cancer. 2020 Aug 12;20(1):757. doi: 10.1186/s12885-020-07244-y.

Enikeev D, Taratkin M, Amosov A, Rivas JG, Podoinitsin A, Potoldykova N, Karageziyan M, Glybochko P, Barret E. Whole-gland ablation therapy versus active surveillance for low-risk prostate cancer: a prospective study. Cent European J Urol. 2020;73(2):127-133. doi: 10.5173/ceju.2020.0009. Epub 2020 Apr 8.

Mantica G, Chierigo F, Suardi N, Rivas JG, Kasivisvanathan V, Papalia R, Fiori C, Porpiglia F, Terrone C, Esperto F; ESRU (European Society of Residents in Urology). Minimally invasive strategies for the treatment of prostate cancer recurrence after radiation therapy: a systematic review. Minerva Urol Nefrol. 2020 Aug 4. doi: 10.23736/S0393-2249.20.03783-2.

Wu YT, Chiang PH. Cohort study of high-intensity focused ultrasound in the treatment of localised prostate cancer treatment: Medium-term results from a single centre. PLoS One. 2020 Jul 23;15(7):e0236026. doi: 10.1371/journal.pone.0236026. eCollection 2020.

Khoo CC, Miah S, Connor MJ, Tam J, Winkler M, Ahmed HU, Shah TT. A systematic review of salvage focal therapies for localised non-metastatic radiorecurrent prostate cancer. Transl Androl Urol. 2020 Jun;9(3):1535-1545. doi: 10.21037/tau.2019.08.21.

Reddy D, Bedi N, Dudderidge T. Focal therapy, time to join the multi-disciplinary team discussion? Transl Androl Urol. 2020 Jun;9(3):1526-1534. doi: 10.21037/tau.2019.09.30.

Bedi N, Reddy D, Ahmed HU. Targeting the cancer lesion, not the whole prostate. Transl Androl Urol. 2020 Jun;9(3):1518-1525. doi: 10.21037/tau.2019.09.12.

Royce PL, Ooi JJY, Sothilingam S, Yao HH. Survival and quality of life outcomes of high-intensity focused ultrasound treatment of localized prostate cancer. Prostate Int. 2020 Jun;8(2):85-90. doi: 10.1016/j.prnil.2019.12.002. Epub 2020 Mar 12.

Huber PM, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, Guillaumier S, Hindley RG, Hosking-Jervis F, Leemann L, Lewi H, McCartan N, Moore CM, Nigam R, Odgen C, Persad R, Virdi J, Winkler M, Ahmed HU. Focal HIFU therapy for anterior compared to posterior prostate cancer lesions. World J Urol. 2020 Jul 7. doi: 10.1007/s00345-020-03297-7.

Ziglioli F, Baciarello M, Maspero G, Bellini V, Bocchialini T, Cavalieri D, Bignami EG, Maestroni U. Oncologic outcome, side effects and comorbidity of high-intensity focused ultrasound (HIFU) for localized prostate cancer. A review. Ann Med Surg (Lond). 2020 May 30;56:110-115. doi: 10.1016/j.amsu.2020.05.029. eCollection 2020 Aug.

Shoji S, Hiraiwa S, Uemura K, Nitta M, Hasegawa M, Kawamura Y, Hashida K, Hasebe T, Tajiri T, Miyajima A. Focal therapy with high-intensity focused ultrasound for the localized prostate cancer for Asian based on the localization with MRI-TRUS fusion image-guided transperineal biopsy and 12-cores transperineal systematic biopsy: prospective analysis of oncological and functional outcomes. Int J Clin Oncol. 2020 Jun 17. doi: 10.1007/s10147-020-01723-9.

Maoui M, Gonindard-Melodelima C, Chapet O, Colombel M, Ruffion A, Crouzet S, Rouvière O. Candidates to salvage therapy after external-beam radiotherapy of prostate cancer: Predictors of local recurrence volume and metastasis-free survival. Diagn Interv Imaging. 2020 Jun 10:S2211-5684(20)30153-4. doi: 10.1016/j.diii.2020.05.007.

Westhoff N, Ernst R, Kowalewski KF, Schmidt L, Worst TS, Michel MS, von Hardenberg. Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer. J.World J Urol. 2020 Jun 12. doi: 10.1007/s00345-020-03301-0.

Bacchetta F, Martins M, Regusci S, Jichlinski P, Meuwly JY, Lucca I, Valerio M. The Utility of intraoperative contrast-enhanced ultrasound in detecting residual disease after focal HIFU for localized prostate cancer. Urol Oncol. 2020 Jun 9:S1078-1439(20)30215-5. doi: 10.1016/j.urolonc.2020.05.010.

Ghafoor S, Becker AS, Stocker D, Barth BK, Eberli D, Donati OF, Vargas HA. Magnetic resonance imaging of the prostate after focal therapy with high intensity focused ultrasound. Abdom Radiol (NY). 2020 May 23. doi: 10.1007/s00261-020-02577-5.

Stabile A, Orczyk C, Giganti F, Moschini M, Allen C, Punwani S, Cathala N, Ahmed HU, Cathelineau X, Montorsi F, Emberton M, Briganti A, Sanchez-Salas R, Moore CM. The Role of Percentage of Prostate-specific Antigen Reduction After Focal Therapy Using High-intensity Focused Ultrasound for Primary Localised Prostate Cancer. Results from a Large Multi-institutional Series. Eur Urol. 2020 May 19:S0302-2838(20)30336-5. doi: 10.1016/j.eururo.2020.04.068.

Reddy D, Shah TT, Dudderidge T, McCracken S, Arya M, Dobbs C, Emberton M, Fiorentino F, Day E, Prevost AT, Staffurth J, Sydes M, Winkler M, Ahmed HU. Comparative Healthcare Research Outcomes of Novel Surgery in prostate cancer (IP4-CHRONOS): A prospective, multi-centre therapeutic phase II parallel Randomised Control Trial. Contemp Clin Trials. 2020 Apr 14:105999. doi: 10.1016/j.cct.2020.105999.

Napoli A, Alfieri G, Scipione R, Leonardi A, Fierro D, Panebianco V, De Nunzio C, Leonardo C, Catalano C. High-intensity focused ultrasound for prostate cancer. Expert Rev Med Devices. 2020 Apr 10. doi: 10.1080/17434440.2020.1755258.

Ahmed HU, Huber P, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, Guillaumier S, Hindley RG, Hosking-Jervis F, Leeman L, Lewi H, McCartan N, Moore C, Nigam AK, Ogden C, Persad R, Thalmann G, Virdi J, Winkler M. An exploratory study of dose escalation versus standard focal High Intensity Focused Ultrasound for treating non-metastatic prostate cancer. J Endourol. 2020 Apr 7. doi: 10.1089/end.2019.0613.

Guo X, Zhu H, Zhou K, Chengbing J, Yang Y, Zhang J, Yang W, Ran L, Dimitrov D. Effects of high-intensiry focused ultrasound treatment on peripancreatic arterial and venous blood vessels in pancreatic cancer. April 3, 2020.

Nahar B, Bhat A, Reis IM, Soodana-Prakash N, Becerra MF, Lopategui D, Venkatramani V, Patel R, Madhusoodanan V, Kryvenko ON, Ritch CR, Gonzalgo ML, Punnen S, Parekh DJ. Prospective Evaluation of Focal High-Intensity Focused Ultrasound (HIFU) for Patients with Localized Prostate Cancer. J Urol. 2020 Mar 13:101097JU0000000000001015. doi: 10.1097/JU.0000000000001015.

Rigo M, Mazzola R, Napoli G, Giaj-Levra N, Figlia V, Nicosia L, Ricchetti F, Tomasini D, Bonù ML, Cuccia F, Bellorofonte C, Alongi F. Post-HIFU locally relapsed prostate cancer: high-dose salvage radiotherapy guided by molecular imaging. Radiol Med. 2020 Feb 19. doi: 10.1007/s11547-020-01148-4.

Connor MJ, Gorin MA, Ahmed HU, Nigam R. Focal therapy for localized prostate cancer in the era of routine multi-parametric MRI. Prostate Cancer Prostatic Dis. 2020 Feb 12. doi: 10.1038/s41391-020-0206-6. Review.

Lovegrove CE, Peters M, Guillaumier S, Arya M, Afzal N, Dudderidge T, Hosking-Jervis F, Hindley RJ, Lewi H, McCartan N, Moore CM, Nigam R, Ogden C, Persad R, Virdi J, Winkler M, Emberton M, Ahmed HU, Shah TT, Minhas S. Evaluation of functional outcomes after a second focal high-intensity focused ultrasonography (HIFU) procedure in men with primary localized, non-metastatic prostate cancer: results from the HIFU Evaluation and Assessment of Treatment (HEAT) registry. BJU Int. 2020 Jan 23. doi: 10.1111/bju.15004.

Huber PM, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, Guillaumier S, Hindley RG, Hosking-Jervis F, Leemann L, Lewi H, McCartan N, Moore CM, Nigam R, Odgen C, Persad R, Thalmann GN, Virdi J, Winkler M, Ahmed HU. Prostate Specific Antigen Criteria to Diagnose Failure of Cancer Control following Focal Therapy of Nonmetastatic Prostate Cancer Using High Intensity Focused Ultrasound. J Urol. 2020 Jan 13:101097JU0000000000000747. doi:10.1097/JU.0000000000000747.

Dosanjh A, Harvey P, Baldwin S, Mintz H, Evison F, Gallier S, Trudgill N, James ND, Sooriakumaran P, Patel P. High-intensity Focused Ultrasound for the Treatment of Prostate Cancer: A National Cohort Study Focusing on the Development of Stricture and Fistulae. Eur Urol Focus. 2020 Jan 7. pii: S2405-4569(19)30355-4. doi: 10.1016/j.euf.2019.11.014.

Click here for additional references from PubMed.

Video courtesy of SonaCare Medical

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