Extra-target low-risk prostate cancer: implications for focal high-intensity focused ultrasound of clinically significant prostate cancer

Annoot, A.; Olivier, Jonathan; Valtille, P.; Deken, Valérie; Leroy, Xavier; Puech, Philippe; Villers, Arnauld

doi:10.1007/s00345-018-2442-0

Cited by 11 publications

(23 citation statements)

References 24 publications

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“…This method is expected to maintain oncologic outcomes and reduce morbidity rates compared to whole-gland ablation. Most studies of partial-gland HIFU ablation included low- and intermediate-risk patients [ 24 25 26 27 28 29 ], but three recent studies have included high-risk patients as well [ 30 31 32 ]. Baseline PSAs were reported to be lower than eight ng/mL, and most studies used multiparametric MRIs and mapping biopsies for tumor localization.…”

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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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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“…Nine case series reporting on a total of 1698 patients from 45 to 81 years old were identified (Table 4 ). [ 21 – 29 ] Most patients were stage T1 or T2 PCa, only 2 studies included patients with stage T3 PCa. [ 25 , 28 ] All of the pre-HIFU mean/median PSA levels were ⩽8 ng/mL.…”

Section: Resultsmentioning

confidence: 99%

“…[ 25 ] TURP was only performed in patients at risk of urinary retention or to prevent early acute urinary retention (AUR). [ 21 , 29 ] The duration of follow-up ranging from 1 to 131 months. Among the studies, systematic biopsy plus targeted biopsy with fusion magnetic resonance imaging (MRI) are reported.…”

Section: Resultsmentioning

confidence: 99%

“…Among the studies, systematic biopsy plus targeted biopsy with fusion magnetic resonance imaging (MRI) are reported. [ 21 , 22 , 24 , 27 ] There was only 1 study in which patients underwent a single ultrasound-guided puncture, with range number of cores being 20 to 69. [ 23 ] In most studies, patients underwent repeat biopsy 12 months after HIFU treatment or due to PSA elevation, [ 21 , 22 – 25 , 29 ] while another study performed biopsy at 6 months after treatment.…”

Section: Resultsmentioning

confidence: 99%

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

Tan

et al. 2020

Medicine

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Background: We systematically evaluated the evidences on oncological and functional outcomes of high-intensity focused ultrasound (HIFU) as the primary treatment for localized prostate cancer (PCa). Methods: A systematic review was used Medline, Embase, and the Cochrane Library from the inception of each database. The review analyzed the oncological and functional outcomes of HIFU in the treatment of PCa. The RevMan 5.3 software was used for quantity analysis incidence of complications. Results: Twenty-seven articles were included for analysis with a total of 7393 patients. Eighteen studies investigated the whole-gland HIFU, and the duration of follow-up ranged from 2 to 168 months. After whole-gland HIFU, the mean prostate-specific antigen (PSA) nadir was found to be 0.4 to 1.95 ng/mL and the mean time to PSA nadir was 2.4 to 5.4 months. The rate of positive biopsy after HIFU was 4.5% to 91.1%. Meta-analysis revealed the incidences of urinary incontinence, impotence, urinary obstruction, retention, and infection was 10%, 44%, 15%, 11%, 7%, respectively. Nine studies investigated partial-gland HIFU, and the duration of follow-up was 1 to 131 months. After partial-gland HIFU, the mean PSA nadir was 1.9 to 2.7 ng/mL and the mean time to PSA nadir 5.7 to 7.3 months. The rate of positive biopsy after HIFU in the treatment area was 14% to 37.5%. Meta-analysis revealed the incidences of urinary incontinence, impotence, urinary obstruction, retention, and infection was 2%, 21%, 2%, 9%, 11%, respectively. Conclusions: Early evidence suggested the partial-gland HIFU was safer than whole-gland HIFU, and they had similar oncological outcomes. More prospective randomized controlled trials of whole-gland and partial-gland HIFU for PCa was needed.

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“…The management of presumed low-risk prostate cancer has also evolved from radical to focal therapy and active surveillance due to the visualization of significant lesions in MRI and the predictive value of imaging in the negative part of the gland. Through a single-centre report of patients treated by high-intensity focused ultrasound hemiablation, Dr Villers and his team showed that pathologically insignificant, MRI-negative, extra-target disease did not influence the follow-up course and did not have an impact on the radical treatment-free survival [10]. In active surveillance protocols, the strong negative value of MRI could also avoid the use of confirmatory biopsies in case of negative MRI at entry, and thereby improve patient's heath-related quality of life while avoiding biopsy complications [11].…”

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confidence: 99%

MRI-targeted biopsies: What’s next?

Ploussard

Briganti²

2019

World J Urol

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Extra-target low-risk prostate cancer: implications for focal high-intensity focused ultrasound of clinically significant prostate cancer

Abstract: Presence or not of an extra-target NCSC in the untreated part of the gland had no impact on RTFS. NCSC lesion can be left untreated and actively monitored. RTFS was 80% at 3 years which support the concept of focal/partial treatment as a treatment option of CSC prostate cancer.

Cited by 11 publications

References 24 publications

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

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

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

MRI-targeted biopsies: What’s next?

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