High-intensity focused ultrasound (HIFU) for prostate cancer - step by step technique

• Step-by-step guide for HIFU using FocalOne for localized prostate cancer. • MRI-US fusion ensures precise targeting and reduces damage to healthy tissue. • Real-time monitoring and robotic precision enhance treatment safety and outcomes. • HIFU preserves organs while minimizing urinary and sexual function complications. • Comprehensive follow-up includes PSA monitoring, MRI, and control biopsies. High-Intensity Focused Ultrasound (HIFU) offers a minimally invasive option for localized prostate cancer (PCa), targeting lesions while preserving unaffected tissue. This article outlines a step-by-step guide for performing HIFU using the FocalOne robotic system. From patient preparation to post-procedure validation, this manuscript aims to provide a comprehensive protocol to achieve precise and effective outcomes. A 64-year-old male with high blood pressure and atrial fibrillation, managed with apixaban, recently underwent cardioversion. He had no obstructive urinary symptoms, a normal digital rectal exam, and preserved sexual function. A prostate tumor was detected (prostate-specific antigen (PSA) 7.49 ng/dL, density 0.23 ng/mL/cc). Multiparametric MRI revealed a prostate gland volume of 32 cc and a 10 mm PI-RADS 4 lesion in the right anterior transitional zone without extra prostatic extension. Biopsy results showed two cores with International Society of Urological Pathology Grade Group (ISUP) Grade Group 1 and one core with ISUP Grade Group 2 prostate cancer. A right prostate hemiablation was performed in two phases (7 slices in the first phase, 5 in the second) with a total procedure time of 63 min and a treated volume of 14.67 cc. The patient underwent ambulatory surgery with a bladder catheter for 7 days and alpha-blocker therapy. Long-term follow-up includes PSA monitoring, MRI, and control biopsies. This step-by-step guide underscores the precision of HIFU for localized prostate cancer. Adherence to the outlined protocol helps guarantee optimal outcomes and ensures patient safety.