I just want to provide some counterpoints to the very negative statements about HIFU (and by extension other forms of focal therapy) in this thread.
Most importantly, as a scientist, I wanted to comment on the argument made above that HIFU leads to worse cancer recurrence rates than people are told. It is vital that you read the literature carefully, as HIFU has been used in a number of different ways:
(i) As a focal therapy for patients with localised cancer
(ii) As a whole gland therapy for patients with more advanced cancer
(iii) As salvage therapy for those who have had other treatments but have recurrent cancer
The outcomes in each of those are very different, and broadly, the NHS only recommends HIFU should be used in (i), with low grade, early stage, localised cancers. If this protocol is followed then outcomes are exactly as stated by the clinicians. However, many papers in the scientific literature discuss examples of HIFU use in the other settings, where outcomes are worse.
You cannot simply roll all HIFU papers together and assume they are all reporting the same thing. It is vital when looking at published outcomes that you only look at papers where the enrollment criteria are THE SAME as those currently recommended by NICE. Indeed, part of the reason HIFU is limited to low-grade, early-stage, single-focus is because of the papers showing worse outcomes when used on more advanced tumours.
It is therefore very misleading to lump together all of the historic literature to try and come to broad brush conclusions about a technique that has been used in very different ways.
That said, HIFU (and other focal therapies) are obviously not as established as radical prostatectomy (RP) or radiotherapy. If you want greater certainty of outcome, then selecting those modalities is probably better. However, many men have RP and still get recurrent cancer (20-40% get biochemical recurrence within 10 years). Focal therapies do offer much lower risk of side effects and actually, if used on low-grade, early-stage, single-focus tumours, the recurrence rates at 5 years are similar to those after RP.
I acknowledge that some men will have bad experiences with any therapy, and have every right to be heard. But it is also important to present scientific evidence fairly and not to push an agenda.
As for HIFU making radical prostatectomy slightly more difficult as a result of scarring, potentially impacting to a small extent on impotence (but not incontinence) all patients undergoing HIFU are now informed about this. However, surgery is still much easier than after radiotherapy (where it is considered essentially impossible). Previously patients may not have been informed about this, but that was because HIFU was new, and few men would have gone through salvage treatment after HIFU. However, all of those patients were informed that it was a new technique, which has associated risks, and that longer term outcomes were less certain.
[I should note that I recently had Nanoknife treatment of prostate cancer on the NHS, and for me, with the type of cancer I have, and the lifestyle I want to live, this was, in my opinion the right option. Nanoknife is milder than HIFU and works on anterior tumours which HIFU does not. I was informed the treatment was only just past experimental stage and that longer term outcomes were therefore less well-known. I was informed that RP would still be an option should the cancer return, and that evidence currently shows that for Nanoknife this is not significantly more difficult that standard RP, but that it was not without risk.]
Finally, on conflicts of interest, these exist in many areas of experimental medicine. There is certainly a need to manage them robustly. All published work has to clearly declare them, and all papers are reviewed with this information in mind. All clinical trials have to be registered in advance and it is not allowed to cherry-pick the best data. One of the reasons that those closest to the technology have the best outcomes is that they tend to apply the best experimental technique, as they are the most experience, and also select patients the most carefully, as they have the most data about those who benefit the most. This is not a conflict of interest - this is simply how best practice evolves in terms of using a new technique in the clinic. For example, those who get the best results in robot-assisted radical prostatectomy are those who have used the robots the most (all men are advised to ask how many RPs a surgeon has performed). Most of these high-users of robot-assisted RP are those who have worked alongside the companies that make the robots because they were the pioneers of the technique. This is just how medicine works at the cutting edge. So yes there is a need for conflicts of interest to be as robustly managed as possible, and yes there might be some failings, but this is not specific to HIFU or other focal therapies and applies across all areas.