Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer

Abstract

Overtreatment of prostate cancer (PC) remains one of the main burdens in uro-oncology. Focal therapy may be a reasonable alternative with less side effects and morbidity. Application of high-intensity focused ultrasound (HIFU) induces immediate and irreversible coagulation. The treatment leads to consecutive necrosis with sharply delineated margins, making HIFU a promising tool for the focal therapy of localized PC. Unlike radiation, the treatment leaves no collateral damage outside of the heated tissue, allowing repeated use of HIFU, if necessary. In case of non-organ-confined relapse, additional radical salvage therapy can be performed. This review gives an overview of the existing evidence on focal HIFU. Today, 3 HIFU devices are approved for the treatment of localized PC: Sonablate™, Ablatherm™ and the FocalOne™ device. In summary, the first published results of focal HIFU are promising. The quality of life and potency of the patients are well preserved. Therefore, HIFU treatment, and especially focal ablation of tumor foci, seems to be a safe alternative to standard treatment, with low side effects. The oncologic results seem satisfactory but need further follow-up to validate this practice of PC control.

Partial ablation versus radical prostatectomy in intermediate-risk prostate cancer: the PART feasibility RCT

“…Four systematic reviews of HIFU in the treatment of prostate cancer have been published. [21][22][23][24] Warmuth et al 21 identified 20 uncontrolled prospective case series, totalling 3021 patients (2794 primary therapy and 227 salvage therapies). They concluded that, for all HIFU procedures, the biochemical disease-free rate at 1, 5 and 7 years was 78-84%, 45-84% and 69%, respectively.…”

“…Longer-term effects on QoL are unknown. Kuru et al 24 conclude that HIFU treatment, and especially focal ablation of tumour foci, seems to be a safe alternative to standard treatment, with fewer side effects. The oncological results seem satisfactory but need further follow-up to validate this practice of PCa control.…”

“…The oncological results seem satisfactory but need further follow-up to validate this practice of PCa control. 24…”

Histotripsy: The Next Generation of High‐Intensity Focused Ultrasound for Focal Prostate Cancer Therapy

“…It is now commonly believed that the index lesion, defined as the largest lesion detected at imaging, is the one that will be responsible for disease progression . To avoid overtreatment of these lesions and reduce costs, alternative curative therapies that offer rates of cancer control equivalent or better to radical prostatectomy and external radiotherapy are being attempted with greater frequency, particularly in Europe. Such alternative focal therapy treatments offer the advantage of decreased morbidity and therefore an improved quality of life .…”

New Developments in the Management of Prostate Cancer

“…Although a variety of treatment options, such as radical prostatectomy, external beam radiation therapy, brachytherapy, and active surveillance are available for patients with low- and intermediate-risk prostate cancer, focal therapy might emerge as a new, minimally-invasive, and oncologically effective treatment modality due to the improvements of prostate cancer imaging with multiparametric MRI. Timor Kuru and colleagues summarize the current scientific and clinical evidence of the various technologies of focal prostate cancer treatment [2]. For a long time external beam radiation therapy has been the standard therapy for high-risk prostate cancer.…”