High-Intensity Focused Ultrasound for the Treatment of Prostate Cancer: A Review

Abstract

Over the past 25 years, the average life expectancy for men has increased almost 4 years, and the age of prostate cancer detection has decreased an average of 10 years with diagnosis increasingly made at early-stage disease where curative therapy is possible. These changing trends in the age and extent of malignancy at diagnosis have revealed limitations in conventional curative therapies for prostate cancer, including a significant risk of aggressive cancer recurrence, and the risk of long-term genitourinary morbidity and its detrimental impact on patient's quality of life (QOL). Greater awareness of the shortcomings in radical prostatectomy, external radiotherapy, and brachytherapy has prompted the search for alternative curative therapies that offer comparable rates of cancer control and less treatment-related morbidity to better preserve QOL. High-intensity focused ultrasound (HIFU) possesses characteristics that make it an attractive curative therapy option. HIFU is a noninvasive approach that uses precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urologic oncology, HIFU is used clinically in the treatment of prostate cancer and is under experimental investigation for therapeutic use in multiple malignancies. Clinical research on HIFU therapy for localized prostate cancer began in the 1990s, and there have now been ∼65,000 prostate cancer patients treated with HIFU, predominantly with the Ablatherm (EDAP TMS, Lyon, France) device. Neoadjuvant transurethral resection of the prostate has been combined with HIFU since 2000 to reduce prostate size, facilitate tissue destruction, and to minimize side effects. Advances in imaging technologies are expected to further improve the already superior efficacy and morbidity outcomes, and ongoing investigation of HIFU as a focal therapy in salvage and palliative indications is serving to expand the role of HIFU as a highly versatile noninvasive therapy for prostate cancer.

The prostate cancer focal therapy

“…US probes are inserted per rectum and incorporate both imaging and therapeutic transducers in one unit, whereas a prostatededicated MRI-HIFU system makes use of either the transrectal or transurethral approach (87). In addition, neoadjuvant transurethral resection of the prostate can be combined with HIFU to reduce the gland size, facilitate tissue destruction and to minimize side effects (90). For some authors, MRI monitoring can be considered superior to US as a guidance tool because it has better anatomical and contrast resolution.…”

Morphological changes in tumor and nontumor tissue in the treatment of prostate adenocarcinoma with high-intensity focused ultrasound in combination with androgen deprivation

“…Подводя итог, можно сделать вывод, что массивный коагуляционный некроз, вызванный воздействием ВИ-ФУ на ткань ПЖ и обусловленный суммарным биологическим эффектом теплового воздействия, кавитации и разрушения сосудов опухоли [2,14], приводит к запуску каскада длительно и мозаично протекающих процессов, в исходе которых значительная часть пролеченной зоны замещается пролиферирующей фиброзной тканью. С учетом мультифокального характера опухолевого роста основной целью ВИФУ при РПЖ в большинстве случаев является максимально полная деструкция опухолевой и неопухолевой паренхимы.…”

“…Несмотря на совершенствование методов ранней диагностики, доля впервые выявленных больных с распространенным процессом остается высокой (более 50%), значительная часть из них к этому моменту имеет тяжелые сопутствующие заболевания, что затрудняет проведение радикальной простатэктомии [1]. Среди предложенных за последние десятилетия альтернативных малоинвазивных методов лечения особого внимания заслуживает абляция ПЖ высокоинтенсивным фокусированным ультразвуком (ВИФУ), преимуществами которой являются высокие уровни 5-летней безрецидивной выживаемости при лечении локализованных форм РПЖ (66-78%), а также возможность многократного применения в режиме паллиативной терапии [2,3].…”

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

“…As male life expectancy has increased over the last 25 years, the age at which prostate cancer is detected has decreased on average by 10 years . Prostate carcinoma is the most common malignant neoplasm in men .…”

“…Research into the use of HIFU has been ongoing since the 1990s, and at this time, more than 65,000 patients with prostate cancer have been treated with HIFU in Europe . Compared to the other modalities, HIFU ablation offers advantages over other therapies, especially the lack of substantial injury to tissues outside the treatment zone .…”