Five years experience of transrectal high‐intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer

Uchida, Τοyoaki; Ohkusa, Hiroshi; Yamashita, Hideyuki; Shoji, Shuichi; Nagata, Yasutoshi; Hyodo, Toru; Satoh, Takefumi

doi:10.1111/j.1442-2042.2006.01272.x

Cited by 144 publications

(96 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It can be proposed either for patients with clinically localised prostate cancer who are not candidates for surgery [4,5] or as a salvage treatment of local recurrences of prostate cancer after external-beam radiation therapy (EBRT) [6,7]. Five-year disease-free survival rates after HIFU ablation of clinically localised prostate cancer fall within the 66-78% range, which challenges the results of radiation therapy [4,8,9].…”

Section: Introductionmentioning

confidence: 98%

Prostate cancer transrectal HIFU ablation: detection of local recurrences using T2-weighted and dynamic contrast-enhanced MRI

et al. 2009

View full text Add to dashboard Cite

The objective was to evaluate T2-weighted (T2w) and dynamic contrast-enhanced (DCE) MRI in detecting local cancer recurrences after prostate high-intensity focused ultrasound (HIFU) ablation. Fifty-nine patients with biochemical recurrence after prostate HIFU ablation underwent T2-weighted and DCE MRI before transrectal biopsy. For each patient, biopsies were performed by two operators: operator 1 (blinded to MR results) performed random and colour Doppler-guided biopsies ("routine biopsies"); operator 2 obtained up to three cores per suspicious lesion on MRI ("targeted biopsies"). Seventy-seven suspicious lesions were detected on DCE images (n = 52), T2w images (n = 2) or both (n = 23). Forty patients and 41 MR lesions were positive at biopsy. Of the 36 remaining MR lesions, 20 contained viable benign glands. Targeted biopsy detected more cancers than routine biopsy (36 versus 27 patients, p = 0.0523). The mean percentages of positive cores per patient and of tumour invasion of the cores were significantly higher for targeted biopsies (p < 0.0001). The odds ratios of the probability of finding viable cancer and viable prostate tissue (benign or malignant) at targeted versus routine biopsy were respectively 3.35 (95% CI 3.05-3.64) and 1.38 (95% CI 1.13-1.63). MRI combining T2-weighted and DCE images is a promising method for guiding post-HIFU biopsy towards areas containing recurrent cancer and viable prostate tissue.

show abstract

Section: Introductionmentioning

confidence: 98%

Prostate cancer transrectal HIFU ablation: detection of local recurrences using T2-weighted and dynamic contrast-enhanced MRI

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Published rates for post-HIFU stenosis range from 3.6 to 22%. 1,20 A recent study with a mean follow-up of 6.4 years gave a 13.6% rate.…”

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

“…Given this profile of the standard of care for prostate care, opportunities exist for alternative treatments. Ultrasound imaging-guided FUS ablation is such an alternative that is much less invasive than surgery and already has promising results (36,37).…”

Section: Prostatementioning

confidence: 99%

Current status and future potential of MRI‐guided focused ultrasound surgery

Jólesz

McDannold

2008

Magnetic Resonance Imaging

112

View full text Add to dashboard Cite

The combination of the imaging abilities of magnetic resonance imaging (MRI) with the ability to delivery energy to targets deep in the body noninvasively with focused ultrasound presents a disruptive technology with the potential to significantly affect healthcare. MRI offers precise targeting, visualization, and quantification of temperature changes and the ability to immediately evaluate the treatment. By exploiting different mechanisms, focused ultrasound offers a range of therapies, ranging from thermal ablation to targeted drug delivery. This article reviews recent preclinical and tests clinical of this technology. WHILE ITS POTENTIAL has been recognized for decades (1-4), focused ultrasound (FUS) therapy has been in the incubation phase for a long time. Although it has been tested in numerous animal experiments, its widespread clinical realization has lagged, primarily due to the lack of intraprocedural accurate temperature monitoring. When the idea of MRI-guidance was introduced in connection with FUS and MRI thermometry during sonication was demonstrated (5,6), it was anticipated that MR-guided FUS surgery (MRgFUS) would be widely accepted clinically within a few years. Despite these early expectations, there has been relatively slow progress in the clinical implementation of MRgFUS.Early development concentrated primarily on breast tumors (benign fibroadenoma (7,8) and malignant breast cancer (9,10)). These early implementations of the MRgFUS technology motivated the improvement of transducer technology from single-element transducers to MRI-compatible multielement phase arrays (11). There was also significant progress in MRI thermometry and its use to monitor and control sonications. Importantly, too, methods were developed to robustly quantify temperature changes (12). At first, only 2D temperature maps were obtained by MRI to allow for accurate targeting of the beam (13). Later these thermal images were used to generate maps of the thermal dose (14) that could then be used to tailor the energy deposition using closed-loop feedback control (15). This preclinical work led to the development of the first commercial system by InSightec (Haifa, Israel), the Exablate 2000, the first implementation of a fully integrated MRgFUS system that combined a phased array transducer, a computer-controlled robotic positioner, and a workstation that integrated control based on MR thermometry.The early limited clinical trials of breast tumor treatment (8 -10,16,17) were followed by the first major clinical application: the noninvasive therapy of benign uterine fibroids (18,19). The successful Phase I trial was followed by a multicenter . These clinical trials led to the approval of this technology for the treatment of uterine fibroids in several countries, including the United States. Examples of MR thermometry and postablation imaging of a uterine fibroid ablation are shown in Figure 1.The success of uterine fibroid ablation has invigorated the entire field. Technology has rapidly improved and clinical applications ke...

show abstract

Five years experience of transrectal high‐intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer

Cited by 144 publications

References 32 publications

Prostate cancer transrectal HIFU ablation: detection of local recurrences using T2-weighted and dynamic contrast-enhanced MRI

Prostate cancer transrectal HIFU ablation: detection of local recurrences using T2-weighted and dynamic contrast-enhanced MRI

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

Current status and future potential of MRI‐guided focused ultrasound surgery

Contact Info

Product

Resources

About