High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: Results of a prospective study

Abstract

BACKGROUND High‐intensity focused ultrasound (HIFU) consists of focused ultrasound waves emitted from a transducer that are capable of inducing tissue damage. Experimental studies have shown clear damage of malignant tissue exposed to HIFU, but knowledge of in vivo effects is limited. We studied the safety and efficacy of HIFU in patients with a T1−2 N0 M0 prostate carcinoma. METHODS HIFU treatment was performed under general anesthesia with the Ablatherm™ device (Technomed Medical Systems, Lyon, France), 7–12 days prior to radical prostatectomy. Only the lobe in which carcinoma was confirmed was treated. The radical prostatectomy specimen was examined histopathologically, and the changes were compared with treatment goals. RESULTS So far, 9 patients have been treated. On histology, a sharp delineation was noted between areas treated with HIFU and untreated areas. On the dorsal border, however, incomplete destruction of tissue was noted, and in 2 cases a small residual tumor was seen in this region. In all cases complete necrosis was seen in the treated region. CONCLUSIONS Histology reports of radical prostatectomy specimens of patients operated 7–12 days after HIFU treatment showed marked and complete necrosis in the treated area. Due to incomplete tissue destruction at the dorsal side, however, a small focus of residual vital tumor was found in 2 of 9 patients. Prostate 39:41–46, 1999. © 1999 Wiley‐Liss, Inc.

Single High Intensity Focused Ultrasound Session as a Whole Gland Primary Treatment for Clinically Localized Prostate Cancer: 10-Year Outcomes

“…In our institution the upper volume limit for HIFU procedures is set to 40 cc and patients with prostates exceeding this threshold are offered androgen deprivation therapy (ADT) which was always discontinued at the time of therapy. All patients undergo a limited transurethral resection of prostate (TURP) at the end of the procedure, to prevent sloughing and acute urinary retention or prolonged need for indwelling catheter and to reduce the rate of urinary tract infection [5]. Complications were prospectively recorded and retrospectively graded according to the Clavien-Dindo score [13, 14].…”

“…Among these therapies, high intensity focused ultrasound (HIFU) emerged as a valid mini-invasive therapy for localised prostate cancer, using focused ultrasound to generate areas of intense heat to induce tissue necrosis. The ability of HIFU to achieve thermoablation of prostatic lesion was proven histologically on operative specimen [5], on MRI imaging [6], and on posttreatment biopsies [7, 8]. …”

Histopathological changes associated with high intensity focused ultrasound (HIFU) treatment for localised adenocarcinoma of the prostate

“…[5][6][7][8] The first clinical experiences using HIFU for prostate cancer have shown eVective tumour destruction. [9][10][11][12] Although many studies have described the clinical eVects of HIFU in patients with prostate disease, knowledge about the histomorphological changes associated with this treatment is limited. 13 In our study, we evaluated the histological changes in prostatectomy specimens of nine patients with prostate cancer after HIFU treatment.…”

The safety and efficacy of irreversible electroporation for the ablation of prostate cancer: a multicentre prospective human in vivo pilot study protocol

“…Beerlage et al 27 performed a phase II study with high-intensity focused ultrasound with a sample size of 20 followed by a published case series of 14 patients. The other studies using radiofrequency (n=14), transurethral ultrasound therapy (n=8) and cryotherapy (n=7) reported similar patient numbers 28–30…”