Prostate Treatment (HIFU/Brachytherapy/Proton)

Several non-surgical treatments are available for localised prostate cancer when whole-gland surgery is undesirable or when focal therapy is appropriate. High-intensity focused ultrasound (HIFU) uses powerful focused sound waves delivered via a transrectal probe to heat and ablate cancerous prostate tissue while sparing adjacent structures, and is performed as a day case. Brachytherapy delivers radiotherapy from within the prostate via radioactive seeds (low-dose-rate) or temporary high-dose-rate catheters, allowing escalated tumour dose with sharp dose fall-off to the rectum and bladder. Proton-beam therapy is an external radiotherapy modality that uses charged particles with a Bragg-peak dose distribution to minimise exit dose to surrounding tissues. These modalities are offered to men with localised prostate cancer who wish to avoid radical prostatectomy, who are unfit for surgery, or who have recurrent disease after previous radiotherapy. According to NHS guidance, focal HIFU and brachytherapy generally have lower rates of erectile dysfunction and urinary incontinence than radical surgery, but recurrence may require salvage treatment. NICE and NHS England commission these treatments for specific risk groups. Hospital stay is short - HIFU is typically a same-day discharge; brachytherapy requires one to two days; proton therapy is delivered as 20-39 outpatient sessions over four to eight weeks, depending on protocol. International patients planning HIFU or brachytherapy generally need 5-7 days in-country, while proton therapy requires a longer stay aligned with the fractionation schedule. Sources: NHS Guy's and St Thomas', NHS UCLH, NICE guidance, NHS England commissioning.