High-Intensity Focused Ultrasound (HIFU) for Prostate Cancer

Murat, François-Joseph; Poissonnier, L.; Pasticier, G.; Gelet, A.

doi:10.1177/107327480701400307

Cited by 45 publications

(29 citation statements)

References 23 publications

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“…Compared to conventional surgery, HIFU treatments can be performed in a single outpatient setting with shorter recovery times which may offer significant benefits for both patients and the cost of managing the disease. [6][7][8][9] Long-term clinical followup of ultrasoundguided transrectal HIFU confirms the feasibility and efficacy of this technique for localized prostate cancer therapy, reporting acceptable local control of disease and some potential for a reduced impact on quality of life. [10][11][12][13][14] Recent investigations have demonstrated the capability of high-intensity ultrasound energy for treating prostate tissues using transrectal, interstitial or transurethral devices.…”

Section: Introductionmentioning

confidence: 71%

“…A ripple artifact was observed which started when the rotation of the device was initiated. This artifact was observed along the phase and frequency axis and followed a sinc function centered on the device but did not affect the treatment controller decision significantly since: (i) it concerned four particular angles only, (ii) the controller decisions were updated every 7 s, while the rotation rate was continuous with a non-null minimum rate (8 • /min), and (iii) the artifact decreased rapidly with the distance from the device (urethra). For distances greater than 20 mm, the artifact amplitude was less than 10% of its maximum amplitude.…”

Section: Iiib1 Experimental Mr Thermometry Feedback Control Of Thementioning

confidence: 99%

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Coagulation of human prostate volumes with MRI-controlled transurethral ultrasound therapy: Results in gel phantoms

et al. 2012

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Purpose:The feasibility and safety of magnetic resonance imaging (MRI)-controlled transurethral ultrasound therapy were demonstrated recently in a preliminary human study in which a small subvolume of prostate tissue was treated prior to radical prostatectomy. Translation of this technology to full clinical use, however, requires the capability to generate thermal coagulation in a volume up to that of the prostate gland itself. The aim of this study was to investigate the parameters required to treat a full 3D human prostate accurately with a multi-element transurethral applicator and multiplanar MR temperature control. Methods: The approach was a combination of simulations (to select appropriate parameters) followed by experimental confirmation in tissue-mimicking phantoms. A ten-channel, MRI-compatible transurethral ultrasound therapy system was evaluated using six human prostate models (average volume: 36 cm 3 ) obtained from the preliminary human feasibility study. Real-time multiplanar MR thermometry at 3 T was used to control the spatial heating pattern in up to nine planes simultaneously. Treatment strategies incorporated both single (4.6 or 8.1 MHz) and dual (4.6 and 14.4 MHz) frequencies, as well as maximum acoustic surface powers of 10 or 20 W cm −2 . Results: Treatments at 4.6 MHz were capable of coagulating a volume equivalent to 97% of the prostate. Increasing power from 10 to 20 W cm −2 reduced treatment times by approximately 50% with full treatments taking 26 ± 3 min at a coagulation rate of 1.8 ± 0.4 cm 3 min −1 . A dual-frequency 4.6/14.4 MHz treatment strategy was shown to be the most effective configuration for achieving full human prostate treatment while maintaining good treatment accuracy for small treatment radii. The dual-frequency approach reduced overtreatment close to the prostate base and apex, confirming the simulations. Conclusions: This study reinforces the capability of MRI-controlled transurethral ultrasound therapy to treat full prostate volumes in a short treatment time with good spatial targeting accuracy and provides key parameters necessary for the next clinical trial.

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Section: Introductionmentioning

confidence: 71%

Section: Iiib1 Experimental Mr Thermometry Feedback Control Of Thementioning

confidence: 99%

Coagulation of human prostate volumes with MRI-controlled transurethral ultrasound therapy: Results in gel phantoms

et al. 2012

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“…10 The de novo postoperative ED rate in our study was 77.1% when compared with rates of 20 and 77% in recent studies. 23,24 We prescribed postoperative ED therapy to a higher proportion of patients (n ¼ 8, 29.6%) than did another study (20%). 25 However, our study was not a review of a prospectively maintained database, the population size was relatively small and we did not use a validated potency questionnaire.…”

Section: Discussionmentioning

confidence: 97%

Transrectal high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer: review of technical incidents and morbidity after 5 years of use

Ripert

Azemar

Menard

et al. 2010

Prostate Cancer Prostatic Dis

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The objective of this study was to report on technical incidents and early and late complications occurring in high-intensity focused ultrasound (HIFU) treatment of patients with localized prostate cancer. We performed a retrospective review of patients who were treated by Ablatherm at our centre. We recorded all technical incidents, treatment discontinuations and early (o1 month) and late complications. A total of 74 HIFU procedures were performed in 65 patients (55 first-line HIFU treatments and 10 cases of salvage therapy after radiotherapy) over a 5-year period. Median followup was 41 months (10-64 months). All the procedures were well tolerated and no intra-or perioperative deaths occurred. Six technical incidents in the overall population (8.1%) led to discontinuation of the procedure. The early complication rate in patients undergoing first-line HIFU was 36.4%: urinary retention (20%), dysuria (5.4%), urinary infection (3.6%), haematuria (3.6%) and urethral stenosis (3.6%). The late complication rate was 12.7%: urethral stenosis (9%) and dysuria (3.6%). There were no cases of rectourethral fistula. The long-term urinary incontinence rate was 20% and the de novo erectile dysfunction rate was 77.1%. Nine complications (16.4%) required surgical management. The overall complication rate was 49%. Ablatherm is a reliable technique with a relatively high complication rate. However, most complications were minor and required surgical management in a few cases only. Our results confirm that all patients who are offered HIFU treatment should be properly informed of the risks, in particular with regard to continence and sexual function.

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“…Relative contraindications include large volumes of intraprostatic calcifications, which can impair ultrasonic wave transmission. 29 Any rectal pathology can also be a contraindication in the primary setting. In the salvage setting, significant radiation proctitis and anal canal stenosis are definite contraindications.…”

Section: Contraindicationsmentioning

confidence: 99%

Salvage HIFU for recurrent prostate cancer after radiotherapy

Chalasani

Martínez

Lim

et al. 2008

Prostate Cancer Prostatic Dis

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Recurrent disease following primary radiotherapy for localized prostate cancer is a common problem, occurring in up to 46% of patients. For these patients, therapeutic options include salvage prostatectomy, salvage cryotherapy, salvage high-intensity focused ultrasound (HIFU), hormonal therapy or observation. This review will focus on the emerging evidence for salvage HIFU. There are no randomized or prospective studies in this area. Efficacy results of 17-57% have been reported from retrospective case series, with reported toxicity including rectal fistula in 0-16%, and incontinence in 10-50%. The ideal patient, while yet to be clearly defined, should have preradiotherapy low or intermediate risk disease. Salvage HIFU appears most appropriate for those patients with histologically proven local recurrence only, with a life expectancy of at least 5 years and with some medical comorbidities rendering them not ideal for salvage prostatectomy.

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High-Intensity Focused Ultrasound (HIFU) for Prostate Cancer

Abstract: Although HIFU is a recent and emerging technology, it has been well studied and developed to a point that HIFU will undoubtedly be an effective alternative to radiation therapy.

Cited by 45 publications

References 23 publications

Coagulation of human prostate volumes with MRI-controlled transurethral ultrasound therapy: Results in gel phantoms

Coagulation of human prostate volumes with MRI-controlled transurethral ultrasound therapy: Results in gel phantoms

Transrectal high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer: review of technical incidents and morbidity after 5 years of use

Salvage HIFU for recurrent prostate cancer after radiotherapy

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