HIFU is being used in a number of centres in the UK and those I know of involve excellent mainstream urologists. It consists of placing a probe in the rectum and using a guidance system from a previous MRI to direct the beam. Takes 40 to 120 minutes, normally under anaesthesia. They used to catheterise patients for a few days, but this is now less common and patient goes home 30 minutes later.
The great benefit is the non invasive nature of the treatment compared to radical prostatectomy. There have been a couple of papers suggesting this is a good option for some patients. Hashim Ahmed at Imperial Hospital London reported 172 day case procedures noting low complication rates and good results as follows:
0.7% of patients had incontinence (requiring pads), 30% erectile dysfunction and none developed a rectourethral fistula or bowel dysfunction. Overall, there was no evidence of disease in 92.4% after one HIFU session, at a mean follow-up of 12 months. Focal therapy using HIFU might offer the greatest potential in reducing morbidity further
My understanding is that the machines were nor FDA approved and so could not be used in the US - they were bringing US patients to the UK for HIFU not long ago.
The issue seems to be that the treatment recommended depends to a degree on the interests of the individual urologist - some urologists only do robotic prostatectomy, others only do HIFU. The advice must be early diagnosis with MRI and template biopsy followed by cross examination of your urologist as to the risks and benefits of the various treatments, but if my tumour were suitable I would prefer HIFU to surgery or brachytherapy, if I had a prostate !