The primary treatment of prostate cancer with high-intensity focused ultrasound

He, Yue; Tan, Ping Yee; He, Meiling; Hu, Liang; Ai, Jianzhong; Yang, Lu; Wei, Qiang

doi:10.1097/md.0000000000022610

Cited by 25 publications

(21 citation statements)

References 37 publications

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“…Ultrasonography was developed in the 1940s to image tissue transcutaneously; diagnostic ultrasound energy delivery to imaged tissues is low. High intensity focused ultrasound (HIFU) delivers 4–6 orders of magnitude greater energy to tissues, and is used clinically as a non-invasive technique to ablate tissue, for example, prostate cancer and uterine fibroids 13. HIFU is increasingly investigated for its potential in modulating the central nervous system, specifically to treat diseases such as essential tremor, Parkinson’s disease, obsessive–compulsive disorder, neuropathic pain, and depression 14…”

Section: Introductionmentioning

confidence: 99%

Dose-dependent effects of high intensity focused ultrasound on compound action potentials in an ex vivo rodent peripheral nerve model: comparison to local anesthetics

Anderson

Delgado

Sun

et al. 2022

Reg Anesth Pain Med

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BackgroundIn animal models, focused ultrasound can reversibly or permanently inhibit nerve conduction, suggesting a potential role in managing pain. We hypothesized focused ultrasound’s effects on action potential parameters may be similar to those of local anesthetics.MethodsIn an ex vivo rat sciatic nerve model, action potential amplitude, area under the curve, latency to 10% peak, latency to 100% peak, rate of rise, and half peak width changes were assessed after separately applying increasing focused ultrasound pressures or concentrations of bupivacaine and ropivacaine. Focused ultrasound’s effects on nerve structure were examined histologically.ResultsIncreasing focused ultrasound pressures decreased action potential amplitude, area under the curve, and rate of rise, increased latency to 10% peak, and did not change latency to 100% peak or half peak width. Increasing local anesthetic concentrations decreased action potential amplitude, area under the curve, and rate of rise and increased latency to 10% peak, latency to 100% peak, and half peak width. At the highest focused ultrasound pressures, nerve architecture was altered compared with controls.DiscussionWhile some action potential parameters were altered comparably by focused ultrasound and local anesthetics, there were small but notable differences. It is not evident if these differences may lead to differences in clinical pain effects when focused ultrasound is applied in vivo or if focused ultrasound pressures that result in clinically relevant changes damage nerve structures. Given the potential advantages of a non-invasive technique for managing pain conditions, further investigation may be warranted in an in vivo pain model.

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Section: Introductionmentioning

confidence: 99%

Dose-dependent effects of high intensity focused ultrasound on compound action potentials in an ex vivo rodent peripheral nerve model: comparison to local anesthetics

Anderson

Delgado

Sun

et al. 2022

Reg Anesth Pain Med

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“…Although whole-gland HIFU has yielded promising oncological results, morbidity rates remain high. Urinary incontinence, erectile dysfunction, urinary retention, urinary infection, and bladder neck/urethral stenoses rates were 10%, 44%, 11%, 7%, and 15%, respectively [ 23 ]. The most severe complication was the urethrorectal fistula, the rate of which was reported to be less than 2%.…”

Section: Resultsmentioning

confidence: 99%

Clinical application of the therapeutic ultrasound in urologic disease: Part II of therapeutic ultrasound in urology

Choi

et al. 2022

Investig Clin Urol

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This article aimed to review the clinical application and evidence of the therapeutic ultrasound in detail for urological diseases such as prostate cancer, kidney tumor, erectile dysfunction, and urolithiasis. We searched for articles about high-intensity focused ultrasound (HIFU), extracorporeal shock wave therapy, ultrasound lithotripsy, and extracorporeal shockwave lithotripsy (ESWL) in the MEDLINE and Embase. HIFU may be indicated as a primary treatment for low- or intermediate-risk prostate cancer, and salvage therapy for local recurrence as a promising way to address the limitations of current standard therapies. The application of HIFU in treating kidney tumors has scarcely been reported with unsatisfactory results. Evidence indicates that low-intensity shockwave therapy improves subjective and objective erectile function in patients with erectile dysfunction. Regarding the application of ultrasound in stone management, the novel combination of ultrasound lithotripsy and other energy sources in a single probe promises to be a game-changer in efficiently disintegrating large kidney stones in percutaneous nephrolithotomy. ESWL is losing its role in managing upper urinary tract calculi worldwide. The burst-wave lithotripsy and ultrasound propulsion could be the new hope to regain its position in the lithotripsy field. According to our investigations and reviews, cavitation bubbles of the therapeutic ultrasound are actively being used in the field of urology. Although clinical evidence has been accumulated in urological diseases such as prostate cancer, kidney tumor, erectile dysfunction, and lithotripsy, further development is needed to be a game-changer in treating these diseases.

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“…Focal therapy with HIFU ablation has proven to be an effective treatment option for prostate cancer with short-to-medium term results [ 9 ]. Besides oncological criteria, the size of the prostate gland also determines the outcome of treatment.…”

Section: Discussionmentioning

confidence: 99%

High-Intensity Focused Ultrasound (HIFU) Focal Therapy for Localized Prostate Cancer with MRI-US Fusion Platform

Yee

Chiu

Teoh

et al. 2021

Advances in Urology

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Objective. The study aimed at investigating the outcome of prostate HIFU focal therapy using the MRI-US fusion platform for treatment localization and delivery. Methods. It is a prospectively designed case series of HIFU focal therapy for localized prostate cancer. The inclusion criteria include clinical tumor stage ≤T2, visible index lesion on multiparametric MRI less than 20 mm in diameter, absence of Gleason 5 pattern on prostate biopsy, and PSA ≤ 20 ng/ml. HIFU focal therapy was performed in the conventional manner in the beginning 50% of the series, whereas the subsequent cases were performed with MRI-US fusion platform. The primary outcome was treatment failure rate which is defined by the need of salvage therapy. Secondary outcomes included tumor recurrence in follow-up biopsy, PSA change, perioperative complications, and postoperative functional outcomes. Results. Twenty patients underwent HIFU focal ablation. HIFU on an MRI-US fusion platform had a trend of a longer total operative time than the conventional counterpart (124.2 min vs. 107.1 min, p = 0.066 ). There was no difference in the mean ablation volume to lesion volume ratio between the two. The mean PSA percentage change from baseline to 6-month is more significant in the conventional group (63.3% vs. 44.6%, p = 0.035 ). No suspicious lesion was seen at 6-month mpMRI in all 20 patients. Two patients, one from each group, eventually underwent radical treatment because of the presence of clinically significant prostate cancer in the form of out-of-field recurrences during follow-up biopsy. No significant difference was observed before and after HIFU concerning uroflowmetry, SF-12 score, and EPIC-26 score. It was observed that energy used per volume was positively correlated with PSA density of the patient (r = 0.6364, p = 0.014 ). Conclusion. In conclusion, HIFU with conventional or MRI-US fusion platform provided similar oncological and functional outcomes.

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The primary treatment of prostate cancer with high-intensity focused ultrasound

Cited by 25 publications

References 37 publications

Dose-dependent effects of high intensity focused ultrasound on compound action potentials in an ex vivo rodent peripheral nerve model: comparison to local anesthetics

Dose-dependent effects of high intensity focused ultrasound on compound action potentials in an ex vivo rodent peripheral nerve model: comparison to local anesthetics

Clinical application of the therapeutic ultrasound in urologic disease: Part II of therapeutic ultrasound in urology

High-Intensity Focused Ultrasound (HIFU) Focal Therapy for Localized Prostate Cancer with MRI-US Fusion Platform

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