High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment

Abstract

SummaryBackgroundHigh-intensity focused ultrasound (HIFU) applies high-intensity focused ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation. This study intended to review HIFU to explain the fundamentals of HIFU, evaluate the evidence concerning the role of HIFU in the treatment of prostate cancer (PC), review the technologies used to perform HIFU and the published clinical literature regarding the procedure as a primary treatment for PC.Material/MethodsStudies addressing HIFU in localized PC were identified in a search of internet scientific databases. The analysis of outcomes was limited to journal articles written in English and published between 2000 and 2013.ResultsHIFU is a non-invasive approach that uses a precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of PC. Clinical research on HIFU therapy for localized PC began in the 1990s, and the majority of PC patients were treated with the Ablatherm device.ConclusionsHIFU treatment for localized PC can be considered as an alternative minimally invasive therapeutic modality for patients who are not candidates for radical prostatectomy. Patients with lower pre-HIFU PSA level and favourable pathologic Gleason score seem to present better oncologic outcomes. Future advances in technology and safety will undoubtedly expand the HIFU role in this indication as more of patient series are published, with a longer follow-up period.

Effect of High-Intensity Focused Ultrasound Versus Plasma Radiofrequency Ablation on Recurrent Allergic Rhinitis

“…The instantaneous high temperature generated by HIFU denatures the tissue, leading to coagulative necrosis, and the free radicals generated also promote the decomposition of cells at the same time. In addition, high-amplitude mechanical waves inactivate cells, and chemical reactions of chemical components in the membrane structure under the action of high-energy ultrasound also promote cell death [21–23]. When energy is concentrated in the submucosa of the nasal cavity, the death of immune cells reduces the release of cytokines and inflammatory mediators.…”

Low temperature plasmas as emerging cancer therapeutics: the state of play and thoughts for the future

“…However, in several pre-clinical studies addressing the combination of radio- and immuno-therapies to improve therapeutic potential [ 78 ], it has been shown that necrotic cell death can increase tumour immunogenicity through induction of heat shock protein expression [ 79 ]. Moreover, necrosis is induced by thermally ablative treatments such as cryotherapy [ 80 ], radiofrequency ablation [ 81 ] and HIFU [ 82 ], and is known to cause local inflammation at the treatment site. As mentioned previously, it has recently been demonstrated that prostate cancer cells cultured directly from patient tissue samples and treated with LTP rapidly initiate necrotic cell death [ 17 ].…”

Levator Ani Necrosis: An Exceptional Complication Occurring after “High Intensity Focused Ultrasound” of the Prostate

“…Despite these safety measures, a review of the literature reported multiple adverse events among patients using HIFU as a primary therapy option in prostate cancer. Adverse events included bladder neck/urethral stenosis/stricture (2–17%), prolonged urinary retention (3–14%), urinary tract infection (2–58%), urinary incontinence (2–34%), rectal burns (0–15%), and rectourethral fistula (0–3%) [ 10 ]. In the same setting, our patient had urinary obstructive symptoms in addition to perianal pain caused by a necrosis of the levator ani that eventually resolved while maintaining residual pain.…”