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High Intensity Focused Ultrasound

Frequently Asked Questions

Where is the procedure performed?

Currently we perform the procedure at Cedar Park Regional Medical Center (1401 Medical Parkway
Cedar Park, TX 78613). This hospital have provided the best price for our patients and there are several very nice hotels for the overnight stay for out-of-town patients the night before the procedure. We have a special rate for patients at the Hotel Granduca (320 S Capital of Texas Hwy, West Lake Hills, TX 78746).

What can I expect during the procedure?

Our procedure is performed in a hospital because a general anesthetic and paralysis is necessary to maintain the robotically controlled preplanning that is required. The procedure takes between 1 and 3 hours. You will need to prepare for the procedure with enemas and 8 hours of fasting.

You will get anesthesia and shouldn’t feel any pain during the procedure. The doctor will thread a small tube called a catheter through the head of your penis and into your bladder to catch urine during the procedure.

Your doctor will put an ultrasound probe into your rectum. It’s a small instrument like the ones used for prostate biopsies. The probe may have one or two crystals inside. Sound waves from a crystal bounce back to a computer to make a picture of the prostate gland. Any MRI images of your cancer will then be used to create a treatment program that is saved with your real-time prostate images. The nerves that control erections and the sphincter that controls continence as well as the delicate rectal wall are all imaged and protected from treatment. The ultrasound energy is then directed precisely to the prostate and temperature and treatment depth is monitored. Care is taken to adjust the treatment as the prostate can change anatomy due to the heat.

After the procedure is done and the anesthesia wears off, you can usually go home. Depending on several factors you will keep the catheter for one or two weeks after the procedure. If you are a Medicare patient, we will arrange home health for catheter management and removal even if you live outside of Austin. Otherwise we will remove your catheter or arrange a local physician to do so.

What does HiFU cost and what will my insurance cover?

The variability of insurance coverage is perhaps the only reason that HiFU has not become a standard for Prostate Cancer management in the United States.

  • For Medicare, Medicare Advantage, Tricare, Medicaid and some VA patients. The procedure is fully covered.
  • For commercially insured or non-insured patients the cost is $13,500 to include the HiFU treatment, anesthesia, machine rental, equipment and hospital fees. For these patients we will also cover the cost of the erectile rehabilitation program that is outlined below.

What tests are usually required prior to the procedure?

Generally, we would like to see:

  • Your pre-biopsy PSA
  • Your actual biopsy results
  • 3T MRI of the prostate
  • Staging examination including a bone scan and CT of the abdomen

We will order these for you in your local area if your do not have them.

Why choose our practice for your HiFU Treatment?

We are a comprehensive prostate cancer and men’s wellness clinic with decades of experience balancing life-saving surgery with lifestyle maximization. You want a practice that has more than one tool for prostate cancer and you want a Urologist in charge of your prostate cancer treatment program, potency and continence. We actively treat hundreds of prostate cancer patients with surgery, radiation, active surveillance and HiFU every year. We have a strong holistic approach that includes nutrition, preventative supplements and aggressive maintenance of your most intimate functions. It is that commitment to your overall health that should compel you to trust us to advise you best on your prostate cancer.

What if I do not live in Austin?

Approximately 70% of our patients travel for treatment. We will try to make the experience as easy as possible. Most of the pre-consultation and preparation is done on the phone. You will meet us the day before the procedure and are free to go home the day of the procedure. We have special rates at several local hotels and will try to help make travel arrangements if needed.

Why might I be asked to have a procedure before the HiFU?

The HiFU technology is somewhat limited on the size of prostate that can be treated. For patients that will undergo FOCAL therapy of only one or more locations of the prostate, the size of the prostate will generally not interfere with the procedure. For those that have extensive cancer and will require WHOLE GLAND treatment may need a pre-HIFU procedure to reduce the size of the prostate. This is generally an overnight or outpatient surgery and can be performed by your local urologist if traveling to Austin if 2 separate visits is not something you would be willing to do. We would encourage you not to let this aspect of the process discourage you. The reasons you would choose HiFU as a means of maintaining lifestyle remains intact.

How am I followed after the HiFU?

We will generally get a PSA level at 3, 6, 9, and 12 months and make a plan afterwards. We will monitor erectile and urinary function and make any necessary plans to address issues. All follow-up, diagnostic testing and labs are covered under most insurance plans.

What if HiFU does not work?

With HiFU, you still have the option of surgical removal or Radiation therapy if the cancer returns. You will also have the opportunity to repeat HiFU if the cancer returns in a different area of the prostate.

Explain your post HiFU Erectile Rehabilitation Program (ERP)?

The energy and temperature from HiFU may affect the Neurovascular Bundles of the prostate and affect erections. In addition, virtually all treatments for prostate cancer result in patients feeling that their erections and flaccid penis are shorter. To help encourage blood flow to the penis and maintain length we will begin a program of high quality L-arginine and curcumin supplements, daily tadalafil and the regular daily use of a Vacuum Erection Device. All instructions will be given at time of consultation and will begin shortly before HiFU.This is also the program we use after a radical robotic prostate removal surgery.

Will I have incontinence after HiFU?

Generally, you will not have STRESS incontinence after the procedure as the urethral sphincter will be visualized and protected from damage. Some patients may have temporary URGE incontinence that can be managed with medication as the prostate heals.

Can I have HifU after radical surgery or radiation if
the cancer returns?

HiFU is not an option after the prostate is removed.

Therapeutic advances and improvements in prostate condition management have recently placed quality of life at the heart of patients’ decision. Quality of life is akin to a person’s judgment on his life and his psychic equilibrium. It is therefore a very subjective concept that makes its assessment difficult. Therapeutic advances, the willingness to involve patients in decisions about themselves, or rationalization of healthcare expenditure may explain why health-related measures of quality of life have been developed in recent years alongside morbidity and mortality indices.

HiFU allows for direct visualization and avoidance of the Neurovascular Bundles (NVB) that control erections and the sphincter that controls continence. When appropriate, these structures can be avoided to maximize your quality of life.

Complications of HiFU can include the development of a Urethral Stricture, narrowing of the urethra that slows or stops urine flow. Another potential complication is a fistula (or unnatural connection) between the urethra and the rectum. This is more common if HiFU is done after radiation. There are precautions taken to avoid these issues and the Ablatherm HiFU device is specifically designed to avoid rectal wall damage.

What is the role of HiFU in oligometastatic disease?

In the past, any evidence of prostate cancer outside of the prostate was considered too advanced for some forms of local therapy. Today, many oncologists believe that evidence of disease in only one or two locations outside of the prostate (oligometastasis) may be treated with therapy directed at the prostate and focal therapy to the areas of spread. HiFU can play a role in these patient with oligometastatic disease in combnation with focused radiation therapy for the areas of spread.


How do I learn more about treatment for myself or a loved one?

Please call us or email us at info@naurology.com and we will set up a FREE telemedicine consultation with one of our UROLOGISTS to discuss YOUR specific case. If you can get your materials together we can discuss your individual case or we can simply talk about the treatment in general terms.

It is up to YOU. Your Cancer…Your Choice.