Control of Prostate Cancer by Transrectal HIFU in 227 Patients

Poissonnier, L.; Chapelon, Jean‐Yves; Rouvière, Olivier; Curiel, Laura; Bouvier, Raymonde; Martín, Xavier; Dubernard, Jean Michel; Gelet, A.

doi:10.1016/j.eururo.2006.04.012

Cited by 298 publications

(249 citation statements)

References 13 publications

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“…Salvage radiotherapy (RT) has recently been described as an option after HIFU failure with reasonable results (12). Even if most of our patients were treated with ADT, focal therapy with HIFU allows many options for salvage therapy such as repeat HIFU (9,11,13), RT (12), and radical prostatectomy (RP) (14) in case of recurrence.…”

Section: Commentsmentioning

confidence: 99%

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

et al. 2011

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Purpose: To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU). Materials and Methods: Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were: PSA ≤ 10 ng/mL, ≤ 3 positive biopsies with only 1 lobe involved, clinical stage ≤ T2a, Gleason score ≤ 7 (3+4), negative CT scan and bone scan. Hemi-ablation of the prostate was performed with the Ablatherm (R) device. Survival, complication rates and urinary continence were evaluated. Control biopsies were performed at 1 year. Treatment failure was defined as a positive biopsy or need for salvage therapy. Results: Twelve patients with a mean age 70 years were included. Median follow-up was 10 years. Control prostate biopsies were negative in 11/12 (91%) patients. Overall survival was 83% (10/12) and cancer specific survival was 100% at 10 years. Two patients died from other causes. Recurrence free survival was 90% (95% CI; 0.71-1) at 5 years, and 38% (95% CI; 0.04-0.73) at 10 years. Five patients had salvage therapy with repeat HIFU (n = 1) or hormonal therapy (n = 4) and all salvage patients were alive at 10 years. No patients developed lymph node or bone metastasis. No patients suffered from urinary incontinence. International Prostate Symptom Score was stable at 1 year. Complications included two urinary tract infections and one episode of acute urinary retention. Conclusions: Hemi-prostate ablation with HIFU can be safely performed in selected elderly patients with adequate longterm cancer control and low complication rates. Results from larger prospective studies using improved imaging techniques and extensive biopsy protocols are awaited.

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Section: Commentsmentioning

confidence: 99%

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

et al. 2011

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“…Given this profile of the standard of care for prostate care, opportunities exist for alternative treatments. Ultrasound imaging-guided FUS ablation is such an alternative that is much less invasive than surgery and already has promising results (36,37).…”

Section: Prostatementioning

confidence: 99%

Current status and future potential of MRI‐guided focused ultrasound surgery

Jólesz

McDannold

2008

Magnetic Resonance Imaging

112

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The combination of the imaging abilities of magnetic resonance imaging (MRI) with the ability to delivery energy to targets deep in the body noninvasively with focused ultrasound presents a disruptive technology with the potential to significantly affect healthcare. MRI offers precise targeting, visualization, and quantification of temperature changes and the ability to immediately evaluate the treatment. By exploiting different mechanisms, focused ultrasound offers a range of therapies, ranging from thermal ablation to targeted drug delivery. This article reviews recent preclinical and tests clinical of this technology. WHILE ITS POTENTIAL has been recognized for decades (1-4), focused ultrasound (FUS) therapy has been in the incubation phase for a long time. Although it has been tested in numerous animal experiments, its widespread clinical realization has lagged, primarily due to the lack of intraprocedural accurate temperature monitoring. When the idea of MRI-guidance was introduced in connection with FUS and MRI thermometry during sonication was demonstrated (5,6), it was anticipated that MR-guided FUS surgery (MRgFUS) would be widely accepted clinically within a few years. Despite these early expectations, there has been relatively slow progress in the clinical implementation of MRgFUS.Early development concentrated primarily on breast tumors (benign fibroadenoma (7,8) and malignant breast cancer (9,10)). These early implementations of the MRgFUS technology motivated the improvement of transducer technology from single-element transducers to MRI-compatible multielement phase arrays (11). There was also significant progress in MRI thermometry and its use to monitor and control sonications. Importantly, too, methods were developed to robustly quantify temperature changes (12). At first, only 2D temperature maps were obtained by MRI to allow for accurate targeting of the beam (13). Later these thermal images were used to generate maps of the thermal dose (14) that could then be used to tailor the energy deposition using closed-loop feedback control (15). This preclinical work led to the development of the first commercial system by InSightec (Haifa, Israel), the Exablate 2000, the first implementation of a fully integrated MRgFUS system that combined a phased array transducer, a computer-controlled robotic positioner, and a workstation that integrated control based on MR thermometry.The early limited clinical trials of breast tumor treatment (8 -10,16,17) were followed by the first major clinical application: the noninvasive therapy of benign uterine fibroids (18,19). The successful Phase I trial was followed by a multicenter . These clinical trials led to the approval of this technology for the treatment of uterine fibroids in several countries, including the United States. Examples of MR thermometry and postablation imaging of a uterine fibroid ablation are shown in Figure 1.The success of uterine fibroid ablation has invigorated the entire field. Technology has rapidly improved and clinical applications ke...

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“…In prostate cancer, HIFU has generally been intended for whole-gland ablation. Early results appear encouraging for use of this approach in properly selected patients with clinically localized disease (114,115).…”

Section: High-intensity Focused Ultrasoundmentioning

confidence: 99%

MRI of the prostate: Clinical relevance and emerging applications

Mazaheri

Shukla–Dave

Muellner

et al. 2011

Magnetic Resonance Imaging

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MRI of the prostate can aid in many aspects of prostate cancer management, from initial detection to treatment planning and follow-up. This review describes the current strengths and limitations of conventional anatomic and molecular MR imaging techniques (including MR spectroscopic imaging and dynamic contrast-enhanced imaging) for aiding prostate cancer management. It also describes promising emerging approaches for acquiring, analyzing, and applying MR imaging data, and the major research and educational efforts that will be required to realize the potential of prostate MR imaging in routine clinical practice.

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Control of Prostate Cancer by Transrectal HIFU in 227 Patients

Cited by 298 publications

References 13 publications

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

Current status and future potential of MRI‐guided focused ultrasound surgery

MRI of the prostate: Clinical relevance and emerging applications

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