High‐intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer

Abstract

What's known on the subject? and What does the study add? Novel therapeutic methods have emerged in recent years as ‘focal’ treatment alternatives in which cancer foci can be eradicated and greatly reducing the associated side‐effects of radical treatment. High‐intensity focused ultrasound (HIFU) seems to result in a well fitted technology, which has proven short‐ to medium‐term cancer control, with a low rate of complications comparable with those of established therapies. This is an up‐to‐date review of the available literature on HIFU as a definitive treatment of prostate cancer. It describes the technique in a comprehensive approach in terms of technical features, procedure, indications, and gives an overview of its historical background; finally, we present the future applications of HIFU and its development trend. OBJECTIVES To provide an up‐to‐date review of the available literature on high‐intensity focused ultrasound (HIFU) as a definitive treatment of prostate cancer. To present the technique in a comprehensive approach, comparing the available devices according to the existing evidence in terms of technical features, procedure, indications, and to give an overview of its historical background; and finally, to discuss future applications of HIFU and its development trend. MATERIALS AND METHODS A systematic literature search was conducted using MEDLINE and EMBASE via Ovid databases (January 2000 to December 2011), to identify studies on HIFU for treatment of prostate cancer. Only English‐language and human‐based full manuscripts that reported on case series studies with >50 participants, patient characteristics, efficacy and safety data were included. RESULTS No randomised controlled trials were identified by the literature search. We identified 31 uncontrolled studies that examined the efficacy of HIFU as primary treatment and two studies that examined the efficacy of HIFU as salvage treatment. Most treated patients had localised prostate cancer (stage T1–T2); Gleason scores of 2–10 and mean prostate specific antigen (PSA) values of 4.6–12.7 ng/mL. The mean age range of the patients was 64.1–72 years. The mean follow‐up ranged from 6.4 to 76.8 months. Negative biopsy rates ranged from 35 to 95%. PSA nadirs ranged from 0.04 to 1.8 ng/mL. The 5‐year disease‐free survival rates ranged from 61.2 to 95%; 7‐ and 8‐year disease free survival rates ranged from 69 to 84%. The most common complications associated with the HIFU procedure as the primary treatment included: urinary retention (<1–20%); urinary tract infections (1.8–47.9%); stress or urinary incontinence (<1–34.3%); and erectile dysfunction (20–81.6%). Recto‐urethral fistula was reported in <2% of patients. Treatment‐related morbidity appeared to be reduced by the combination of transurethral resection (TURP) of the prostate and HIFU. CONCLUSIONS Novel therapeutic methods have emerged in recent years as ‘focal’ treatment alternatives, in which cancer foci could be eradicated by greatly reducing the associated side‐effects of radical treatment. ...

Focal magnetic resonance guided focused ultrasound for prostate cancer: Initial North American experience

“…It also necessitates the insertion of a supra-pubic catheter for varied periods of time. 8 Even non-MR-guided focal HIFU is associated with dysuria (22%), urethral sloughing (34%), urinary tract infection (17%), and necessitates insertion of a supra-pubic catheter. 9 In our first case, we have demonstrated that this procedure can be performed safely with no adverse events up to 1 month post-procedure.…”

The role of magnetic resonance imaging in the diagnosis and management of prostate cancer

“…Medium to long-term outcomes of modern techniques are not yet available [130,131], but short-term outcomes appear favourable for selected men in recent studies [132], especially those where mpMRI was used together with template mapping biopsy [133]. The key to a successful outcome with focal therapy lies in the accurate localisation and risk stratification of all foci of clinically significant cancer.…”

Salvage HIFU for biopsy confirmed local prostate cancer recurrence after radical prostatectomy and radiation therapy: Case report and literature review

“…It has become an alternative treatment for low-or intermediate-risk prostate cancer in men over the age of 70 with a prostate volume less than 40 grams. [2][3][4] HIFU is a non-invasive, day procedure resulting in less erectile dysfunction and incontinence than a prostatectomy. 5,6 Additionally, unlike ionizing radiation, HIFU has no lifetime dose limit and does not increase the risk of secondary malignancies later in life.…”