HIFU is a Revolutionary Treatment for Prostate Cancer

What is HIFU?

High Intensity Focused Ultrasound (HIFU) is a remarkable, non-invasive procedure that treats prostate cancer while usually avoiding the two most common, life-altering side effects seen with radical surgery and radiation – permanent bladder control problems and erectile dysfunction.

Dr. Robert Pugach was one of the earliest adopters of HIFU technology. He received his initial training in December 2005 and has been treating patients for more than 15 years. He is now in an elite group of less than 1% of the urologists in the world certified to perform HIFU. He is the 3rd most experienced HIFU urologist in the Western United States and in the top 10 worldwide!

At Western States HIFU, Dr. Robert Pugach uses the Sonablate® 500, a HIFU medical device, to treat men diagnosed with prostate cancer. While there is another device available for HIFU treatments, Dr. Pugach believes the Sonablate® 500 is clearly superior and uses it exclusively for his patients who expect the latest in HIFU technology.

Schedule a HIFU Consultation with Dr. Pugach today.

High Intensity Focused Ultrasound (HIFU) is an advanced technology which deploys focused, high energy, controlled ultrasound waves to heat and destroy the areas of the prostate gland affected by cancer. Every 3-second burst of the HIFU beam heats the target tissue to 88⁰ to 98⁰ centigrade. In some areas, the temperature exceeds 100⁰ so the water in the tissue boils! This instantly destroys the prostate cells in the treated area. Each 3-second burst destroys tissue that is roughly the size of a grain of rice, without damaging surrounding cells. Because each treated area is so small, it takes great skill and precision to treat a prostate adequately with HIFU to ensure optimal results.

View HIFU Procedure!

The small size and precision of the HIFU beam is what allows treated patients to have dramatically less urinary incontinence and erectile dysfunction. These are the two most feared, life-changing side effects that patients worry about and cause many men to avoid treating their prostate cancer.

The ultrasound imaging system that is part of the sophisticated computer software in the Sonablate® 500 HIFU device targets prostate cells without damaging surrounding tissue. That is why HIFU results in excellent cure rates and causes far less incontinence as compared to robotic surgery.

Another feature of the sophisticated HIFU ultrasound system is called Doppler. This allows Dr. Robert Pugach to hear blood flow near the nerves outside the prostate that are important for erections. By programming the blood vessel locations into the treatment software computer, damage to these important nerves and blood vessels can be minimized or prevented. This makes the possibility of erectile dysfunction (ED) very low.

Certainly! Here is a list of some of the advantages that HIFU has compared to radical surgery (robotic or traditional) and radiation (all types): It is important for prostate cancer patients to know that HIFU is a non-invasive procedure.


  • Absolutely no incisions are needed.
  • HIFU is an outpatient procedure done in a surgical center.
  • No hospital stay required.
  • You’ll have a much shorter recovery compared to radical surgery.
  • The treatment takes a few hours as compared to weeks for most radiation treatments.
  • Most normal activities can be resumed in a few days.
  • There is minimal to no pain.
  • HIFU causes a decreased risk of damage to surrounding structures.
  • HIFU has the lowest rate of urinary incontinence.
  • HIFU has the lowest rate of erectile dysfunction.

You may be a good candidate for HIFU if:

  1. You have early stage, a localized prostate cancer that has not spread or metastasized outside the prostate.
  2. You have recurrent prostate cancer after radiation therapy of any type, or if other treatment options pose a high risk of complications.
  3. You want to avoid the side effects and potential complications of radical surgery or radiation.

Dr. Robert Pugach treats prostate cancer at the Los Alamitos Surgery Center. This “triple A” ambulatory surgery center is accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). The level of care and personalized attention at this premier surgical center is unmatched.

HIFU is performed under general, spinal or epidural anesthesia. The procedure takes between 2 and 4 hours depending upon the size and shape of your prostate. After a brief stay in the recovery area, where you’ll be monitored by the surgery center’s nursing staff, you will be discharged home. Read Dr. Pugach’s blog about his HIFU treatment.

All prostates swell due to the heat generated during a HIFU treatment. This makes it impossible to urinate. Just before the HIFU procedure starts, a small tube (catheter) is placed into your bladder through a 3/16” skin opening just above your pubic bone. Until the swelling subsides and you are able to urinate well, the tube will drain urine from your bladder into a small bag that straps onto your leg. It’s under your pants – so no one knows it’s there except you. Unlike catheters used after radical surgery, it does not go through the urethra so it’s far more comfortable and carries a much lower risk of infection.

After about 2 weeks, Dr. Pugach will remove the catheter in our office. It’s a simple procedure that takes about 30 seconds to do and you’ll feel almost nothing when it comes out.

For the next several weeks, patients may pass small amounts of blood, old prostate tissue or mucus-like material in the urinary stream. Once all of the prostate tissue is eliminated most patients urinate better than they did before the HIFU procedure.

Dr. Pugach and his HIFU team will discuss the procedure and your recovery in more detail when you come in for your consultation.

HIFU is a non-invasive, outpatient treatment choice for prostate cancer that does not involve surgery or radiation. After treating thousands of patients with prostate cancer, Dr. Pugach and the professional staff at Western States HIFU can provide detailed information about HIFU to help you decide if this is the right treatment for you. You should always educate yourself fully before deciding upon the best treatment for your prostate cancer.

Our medical director, Dr. Robert Pugach, is one of the most experienced HIFU urologists in the world. After treating hundreds of patients, we know that experience counts to give you the best possible outcome for your prostate cancer!

Call 844-HIFUDOC (844.443.8362) to schedule a personalized consultation with Dr. Robert Pugach to determine if HIFU is right for you!