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HIFU- cancer treatment or cancer risk -Update

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User

Posted 15 Dec 2025 at 14:37

Originally Posted by: Online Community Member

Hello Old Barry and Paulshere

I find this a very interesting thread: I have had my suspicions of HiFu since this is a burning technique, and thus prefer IRE (nanoknife) that induces the cells to fall apart ( thus inducing a immune response that can help reduce the reoccurrence of cancer). In my case I had bone metastasis and tried first - immunotherapy - and then 177Lu therapy (all looks good but it is early days). but anyway my elder brother then found he had a small G7 tumour and was offered IRE to remove it by a London hospital - however when he went for the IRE they changed his treatment to HiFu... This was about 6 months ago and so far all is good so I will keep my fingers crossed. The problem with the IRE ablation is that they need to use needles to apply the voltage - and these needles have a life time of 4 hours and then they have to be replaced - they can not be sterilised and reused - therefore the procedure is expensive since the cost of each new needle from the manufacturer is high.

Please continue to keep us informed.

Crispin

Probably relevant to your brother's case. I was referred to the much referred London Hospital for Focal Treatment by the other generally regarded foremost cancer hospital in the UK due to failed RT. It was made clear to me that depending on the location of my tumor, I would either be treated with HIFU about which we have discussed or Cryotherapy which forms an ice ball which kills the cancer cells. The cost of the trial/study, ('Forecast'), was funded by the Pelican Cancer Foundation . IRE came along later and although not in the trial was to become an option. So now the Focal specialist can select the most suitable of these options. There are also other Focal Treatments that are available abroad such as Tulsa Pro and FLA (Focal Laser Ablation) which is available in the USA. The latter incidentally, can be done in bore but also has it's failures. The leading UK Focal expert was asked about this and said those administering the type of treatment used was determined by what was considered most suitable for a patient and what their team were familiar and comfortable with. Clearly, they can't be expert and experienced in all types of Focal Treatment. (Not all hospital can even provide one or both types of Brachytherapy!) Prostatectomy can't always reach all cancer cells. Some cancer cells are radio resistant so are not killed by radiation and somtimes it is too big an ask for Focal treatment to eradicate extensive tumours. It is therefore most important that the patient understands this in regard to his individual case. I agree with Paul in as much as a man should be told accurate success rates of a treatment in general and as far as possible the odds applicable in his individual case, although the latter may be less easy to determine.

Barry

User

Posted 19 Dec 2025 at 23:48

So I think what I have leant from prostate cancer is;

that as 70% of men get, but will not die of, this disease and in fact are at no risk of death from this disease, is that this is a medical landscape open to a minority of doctors who are keen to exploit the fear in men of the disease and promote mass testing when all that’s required is an intelligent self awareness campaign as was always NHS policy in the sensible past.

That said of course I am deeply sorry for men who are in the minority category and extend my best wishes to them and their loved ones.

User

Posted 21 Dec 2025 at 08:19

Apart from this Forum's other shortcomings, it lacks the option of providing a Poll, as some other forums do. This is unfortunate because I am sure that if there was one, it would overwhelmingly show that members were in favour of screening at 50 or earlier for men that were more susceptible to early/pernicious PCa. My opinion is based not only on views expressed by members of this forum over many years but also on a great debate that took place on this issue some years ago at a gathering of parties involved and/or affected by PCa. That included this charity. The motion was proposed and seconded by two eminent doctors who favoured screening and opposed and seconded by two other eminent doctors. The motion for screening was carried almost unanimously.

Unlike women who are generally more proactive when it comes to health, men are much more reluctant to visit their GP, and need to be invited to take a PSA test and have treatment where appropriate, if the toll of 12,000 deaths pa in the UK is to be reduced. I was struck by the irony in the recent BBC documentary on Chris Hoy. He is a great advocate for screening whereas his Marsden doctor, named in the Daily Express, (although no doubt doing his very best for Chris), was one of the aforementioned doctors I remember opposing screening. Just being made aware won't cut it, so it's not sensible. Nobody in the UK is compelled to be screened or to have treatment.

Barry

User

Posted 21 Dec 2025 at 11:16

Interesting take Barry. Cancer is a highly emotive subject not well understood by the man in the street. Prostate cancer is very different from all other cancers in that it presents a very high prevalence combined with lower lethality. The public debate over screening is largely on a simplistic level such as

Cancer = possible death sentence. Screening = save people from death

other factors are missed in press reports:

-Psychological damage caused to some 12million men (the male population aged over 50) if it was a national screening programme less the 12000 with a lethal version of the disease

-Vested interests at work in the medical profession. Eg focal treatment costs c.£16000 each at an unnamed london clinic.

-Value for money: the high costs of testing many thousands more men is a cost burden to the NHS which deprives resources for other life saving treatments. The video I referenced stated men who have had focal treatment are some of the most surveilled cancer patients in the world. From my own experience, when I presented after PSA test and biopsy with Gleason 3+4 within a year of HIFU treatment (as fully predictable in unsponsored research), I was sent off for a PET scan. I’m still not sure if all those tests were to check for the 5% probability of cancer recurrence, or to keep a lid on the 35% + probability that the HIFU device may actually be a carcinogen as the German Study I referred to suggests.

So the debate is simply different from breast screening and not fully understood by prominent supporters or many journalists

User

Posted 21 Dec 2025 at 14:26

Originally Posted by: Online Community Member

There were a couple of conversations on here about the decision not to screen. I was very surprised how few members were in favour of it. I've tried to find the threads but can't. To me it's as close as the Brexit vote. I just favour no national screening mainly for the reasons Paul has highlighted.

User

Posted 21 Dec 2025 at 18:55

'Screening' is not an invitation for treatment but to put men in a position where they are offered an indication (with increasing accuracy) on whether they have PCa and it's severity, if they choose to take the diagnostic tests. Armed with this information, men can then make an informed decision on whether they wish to have treatment or take their chances and do nothing. Under current guidance, men are told the pros and cons of treating at the outset by their GP before even a PSA test is given but in many cases patients have to plead for this. Under screening by invitation, this would not change except, that those qualifying would be automatically offered a PSA test after being told of the pros and cons by their GP before the test was authorised. (Some proactive men bypass this by getting a PSA test done using another route -their choice). If tests are strongly indicative of PCa that might be treated with advantage, a man is then able to discuss treatment options with his consultant(s) before proceeding, ask questions and is given time to do his research and choose whether he wants treatment and in many cases which treatment if there are options open to him. So 'Screening' is about informing a wider number of men. A survey by this charity reported that slightly more than half of men in the UK didn't even know what a PSA test was, (although this has doubtless changed somewhat with a growing number of celebrity cases now being made public). Not to make men aware is tantamount to denying some men of the potentially life-saving treatment that many of us have had, albeit with some side effects. This would be a further cost in terms of money and resources, but I can think of less deserving causes funded by taxation. These are interesting figures.

AI Overview

Prostate cancer costs the UK healthcare system significant resources, with estimates varying, but recent figures suggest

late-stage treatment alone costs the NHS around £650 million annually, while some analyses point to total costs potentially reaching hundreds of millions, with hormonal therapies being a major expense; a targeted screening program for high-risk men is projected to add only £25 million yearly, offering significant long-term savings.

Key Figures & Costs

Late-Stage Treatment: More than a quarter of prostate cancer diagnoses occur at later stages, costing the NHS approximately £650 million per year due to complex, multi-modal treatments.

Hormonal Therapies: A substantial portion of costs comes from novel hormonal therapies for advanced disease, with one report citing £63.1 million just for these treatments, notes a UK Parliament submission.

Early Diagnosis Savings: Introducing a targeted screening program for high-risk men (Black men, family history) could cost the NHS an extra £25 million annually but potentially save £500 million by identifying cases earlier, according to research from the Institute of Cancer Research (ICR) and Prostate Cancer Research (PCR).

Cost Breakdown

Treatment Complexity: Early-stage care is less costly, but Stage 3 treatment can cost up to £50,000 in the first year, and Stage 4 over £100,000 annually, leading to cumulative costs exceeding £500,000 per patient over time for complex cases, says Claims Media.

Economic Impact

Societal Cost: Beyond direct healthcare, prostate cancer carries broader economic impacts, with studies aiming to quantify lost quality-adjusted life years (QALYs) and overall burdens, though comprehensive figures are complex to calculate.

The Argument for Screening

Reports emphasize that preventative measures, such as a national screening program for at-risk groups, are cost-effective, adding only a small fraction to the NHS budget (around 0.01%) while potentially saving lives and vast sums by avoiding advanced disease treatment.

Prostate cancer screening the impact on the NHS

19 Oct 2025 — This report states a national screening programme targeted at high-risk men is affordable, practical, and a vital step ...

NHS Networks

Reduce cancer inequality and late diagnosis by proactively offering ...

Reduce NHS costs: The total cost to the NHS for treating prostate cancer has been estimated at c. £93 million, with hormonal thera...

UK Parliament

Prostate cancer spit test could save the NHS £500 million a year

12 Oct 2024 — Identify 12,350 people earlier. In the coming year, more than 52,000 people will be diagnosed with prostate cancer. Up .

Life-saving targeted prostate cancer screening would cost ...

Prostate Cancer Research

https://www.prostate-cancer-research.org.uk › life-savin...

14 Oct 2025 — Comparable and reasonable cost: The estimated cost per eligible individual is just £18, aligning with, or below, existing national cancer ...

The cost of cancer: what does it mean for the UK economy?

Cancer Research UK - Cancer News

https://news.cancerresearchuk.org › ... › Latest News

21 Nov 2024 — According to the OECD's modelling, cancer could add £14.4bn to the UK's health spending every year until 2050. That number is likely to be an underestimate.

Late-stage prostate cancer can cost £100k per year to treat

Health & Protection

https://healthcareandprotection.com › late-stage-prostate...

16 Jun 2025 — However, first-year treatment for stage three disease may reach up to £50,000 with stage four potentially exceeding £100,000 per year, the ...

Reduce cancer inequality and late diagnosis by proactively ...

UK Parliament

https://committees.parliament.uk › pdf

PDF

4. Reduce NHS costs: The total cost to the NHS for treating prostate cancer has been estimated at c. £93 million, with hormonal therapy alone costing £63.1 ...

Resource impact report: - Prostate cancer

NICE website

https://www.nice.org.uk › guidance › resources

PDF

The estimated financial impact of implementing this guideline for England in the next 5 years is a cost of £5.1m in 2019/20 rising to £9.3m in 2023/24. These ...

Late diagnosis of prostate cancer could cost employers up ...

Claims Media

https://claimsmag.co.uk › News

23 Jun 2025 — First-year treatment for stage 3 disease may reach up to £50,000, with stage 4 potentially exceeding £100,000 per year. Because advanced ...

Prostate cancer screening the impact on the NHS

NHS Networks

https://networks.nhs.uk › News

20 Oct 2025 — ... prostate cancer would cost the NHS an extra £25 million a year: just 0.01 per cent of the UK's annual NHS budget.

The arguments for and against screening are quite separate from Paul's unfortunate experience of Focal Treatment which like all forms of treatment has its successes and failures. Whilst Paul's views are strongly biased against HIFU due to his personal experience, I am thankful for it because otherwise I would now be permanently on Hormone therapy and its side effects.

Barry

User

Posted 21 Dec 2025 at 19:31

In simple terms I'm in favour of screening for PCa but I must admit to not researching too much. I think I remember seeing percentage comparison PCa/Breast cancer and the number 'saved' via screening for PCa would be very similar to women 'saved' via breast screening. In that respect certainly not right.

However, I have no idea if the overtreatment argument for PCa is the same for breast cancer or if breast cancer is found it has to be treated etc.

Peter

User

Posted 21 Dec 2025 at 21:41

Hi Barry

It is unfair of you to accuse me of bias because of my own experience. Everyone on here has a cancer story. Are they all biased? Rather I would say my own experience gave me a valuable window into the wider treatment landscape and led to considerable research none of which I researched myself, wrote or misrepresented.
I am pleased you found focal treatment helpful. My research suggests that some two thirds of men would have that outcome.
I do not accuse you of bias because of your positive experience.

I am however at a loss to understand why you have not addressed the negative affects upon the mental health of some 70% of the male population and their loved ones who really would be better off not having a cancer diagnosis as it is no risk to their lives (less c.12000 annually, many of whom will already know they have the more serious, form of the disease.)

You have quoted numerous studies by the ‘medical establishment’. I have referenced video evidence which has misled some 17000 members of the public about the negative impact of radical treatment outcomes, post Hifu. A publicly available FOI from the same hospital confirmed this negative outcome to be the case.
With respect, that is not bias on my part but informed opinion.

User

Posted 22 Dec 2025 at 02:09

I've found the discussion on screening.

https://community.prostatecanceruk.org/posts/t32138--Screening-Program-Denied--What-s-Your-Take

User

Posted 22 Dec 2025 at 04:16

Paul,

I said, bias due to your experience because any open minded person reading your comments can see a constant barrage of comment trying to knock HIFU as a treatment. You would not have done so had it worked well for you. Be honest with yourself and us. Many other members here have had failed treatments including me but I have never seen such a sustained attack by any member on a particular treatment. You reiterated ref to the very small German trial where they gave up due to poor results, probably due to their inexperience with a new to them novel way of administering treatment. You also repeated ref to UCLH observing that a French trial of HIFU did not show well but as I previously explained, this would have been done with the French Ablatherm rather than the more advanced Sonablate. (HIFU machines and techniques have improved just as RT ones have and this is an ongoing process.)

The FDA approved HIFU for ablating tissue in 2015 and to get FDA approval is a drawn out and difficult process. NICE originally recognised it in recognised HIFU in 2005 and it started in the UK in 2006 and continues to be subject to review with later guidance(IPG 756) in 2023 acknowledging evolving techniques. This is the latest situation:-
Recent large-scale UK research, including data from the 2024 and 2025 updates to the
HEAT registry and the CHRONOS trial programme, indicates that High-Intensity Focused Ultrasound (HIFU) provides cancer control comparable to radical surgery but with significantly fewer side effects.
Key UK Trial Results (2022–2025)

HEAT Registry (1,379 Patients): This is the most robust dataset for focal HIFU worldwide, tracking men across 13 UK centres over 15 years.
Metastasis-Free Survival: 100% at 7 years.
Failure-Free Survival: 69% at 7 years (stable at 79% in smaller 8-year sub-analyses).
Functional Success: Decisively superior to surgery, with 94% pad-free continence (vs. 61% for surgery) and 82% potency retention (vs. 46% for surgery).
CHRONOS-A Trial: A randomized trial comparing focal therapy (HIFU or cryotherapy) against radical surgery or radiotherapy.
Status: As of 2025, CHRONOS-A remains open at 13 UK sites with a target of 480 men.
Findings: Early results show that while randomizing between focal and radical treatment is difficult due to patient preference, focal HIFU successfully preserves all future treatment options (salvage surgery) if the cancer returns.
PART Trial: Currently recruiting 800 participants across the UK to directly compare partial ablation (including HIFU) with radical treatments for intermediate-risk cancer.

Summary of HIFU Efficacy vs. Surgery
Metric
Focal HIFU (UK Data) Radical Surgery (RP)
8-Year Cancer Control ~79% failure-free survival ~83% failure-free survival
Urinary Continence ~94-98% (no pads) ~61% (no pads)
Potency (Erections) ~82% retention ~46% retention
Serious Complications ~0.5% incidence Higher (nerve/bladder damage)
Practical Next Steps

Check Eligibility: Men with localized, intermediate-risk prostate cancer are typically the primary candidates for focal HIFU in the UK.
Consult Specialists: You can ask a consultant urologist if you qualify for the CHRONOS-A Trial or the PART Trial to access these treatments under strict governance.

Focal Therapy Clinical Trials: Evidence Behind Treatment ...

Focal Therapy - GFCT
Reddy et. al. (2022) This study analysed the outcomes of 1,379 men with nonmetastatic prostate cancer treated with focal HIFU acro...
The Graham Fulford Charitable Trust
Does Focal Therapy Work? Success Rates & Clinical Evidence
23 Nov 2025 — Clinical studies confirm safety and efficacy. The UK HEAT registry begins collecting data (2005). A landmark UCLH Lance...

As regards Screening (leading to Treatment), I am very familiar with arguments for not having it and know what the medical profession term 'Overtreatment'.* A man has to decide whether he wants to be screened and follow through with treatment or do nothing and chance he will not die prematurely because of PCa but may have treatment he didn't need. It's possible that even if he is treated he will not be cured but at least his chances of later severe adverse effects may be deferred by early intervention. Nobody is forcing a man to have treatment but if he is not made aware, and if not invited to be screened, he may well miss out. I am not posting further on this as the same old arguments have come up from time to time for as long as I have been a member here. Maybe something will come of it as it is now being debated in Parliament but as with that other chestnut 'Assisted Dying', it is likely to be put on the back burner I feel.

https://www.youtube.com/watch?v=m94oEgyKByQ

* A somewhat similar situation with antiCovid vaccinations. Some people decided not to have them and most of these did not succumb to Covid but some did. Some who had the vaccinations doubtless benefitted from taking them whilst in a few cases it was the vaccine that caused them harm. But people were invited to have the ja

I take the opportunity of wishing Paul good luck.

Edited by member 22 Dec 2025 at 17:28 | Reason: addition

Barry

User

Posted 22 Dec 2025 at 06:46

Adrian

Many thanks for the link. Some very insightful analysis of a highly emotive subject on there.

Paul

User

Posted 22 Dec 2025 at 08:39

Barry

The purpose of this site IS to share views and experiences of men and their families about their cancer journeys.

Couple of points:

You refer to FDA Approval. It may interest members that FDA approval was originally rejected in the US and only approved with the support of the UK HEAT Registry as Stephanie Gaullaumier makes clear on page 55 of her Doctorate Thesis https://discovery.ucl.ac.uk/id/eprint/10080076/1/Guillaumier_thesis.pdf "The Role of our (UCL's) own academic HIFU Registry has played a crucial role in securing FDA Approval" That Registry is funded from an 'unrestricted grant" direct from the US manufacturer of the Sonablate 500 device, SonaCare Medical.

NICE 2023 management guidance on HIFU is

"1.3.34

Do not offer high-intensity focused ultrasound and cryotherapy to people with locally advanced prostate cancer other than in the context of controlled clinical trials comparing their use with established interventions. [2008]"

https://www.nice.org.uk/guidance/ng131/chapter/recommendations#radical-treatment

Recording the efficacy of the Sonablate device on the HEAT Registry with unrestricted grant funding from the manufacturer is accepted by NICE as a controlled clinical trial. I am concerned, given your own comments which I agree with (29 Dec 2023 in your post "it would seem HIFU can damage some men and this can be problematic when followed by RP." and 30 Dec 2023 "I think alot of manufacturers and providers tend to over egg their products and services." ) that there is insufficient oversight involved of this Registry. If it was not funded by the US manufacturer I would not have concerns.

It seems to me that prostate cancer patients should be told the extent of commercial sponsorship before they commit to a procedure as the GMC requires. https://www.gmc-uk.org/professional-standards/the-professional-standards/identifying-and-managing-conflicts-of-interest/annex-a?utm_source=chatgpt.com

But you are correct that I am not a fan of HIFU but of course I respect any man with a different experience of the treatment providing they have been properly advised of the risks and benefits of the procedure. What I cannot respect is skewed advice from medical professionals to men who have just tipped into a Gleason 4 test result like me to take a treatment on false advice on its efficacy. I am now incontinent and impotent when my cancer was at a level it could have continued to be watched. The reason I referenced the Duwe Study was because it was brought to my attention by a surgeon who removed my prostate at Guys Hospital when the cancer had grown bilaterally within a year of HIFU treatment. He was able to save my nerves but HIFU had already damaged them sufficiently to ensure I am no longer continent or potent.

I have not cherry picked Duwe. My research revealed numerous unsponsored research papers ALL of which report unacceptably high cancer recurrence rates after HIFU of between 35% and 42%:

Bhat 2021 Suny Med School NewYork; (35-40%); Duwe 2022 Gutenberg Dresden (37.93% at 2yrs); Thompson 2019 UCL, UCLH, Imperial, BArts, Q Mary, Oxford (37.1% at 2.4yrs); Thompson 2020 UCL, UCLH, New South Wales, Barts, Queen Mary, Oxford (33.3% at 12mnths); Mortezavi 2019 Zurich (41% at 6mths), Bass 2018 Univ.Toronto (42% at 4yrs)

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