Results and Side Effects of High-Intensity Focused Ultrasound in Localized Prostate Cancer

Abstract

At the time of diagnosis, prostate cancer is organ confined in 70% of the cases. A quarter of these patients undergo local therapy (surgery/radiation); 75% risk disease progression by "watchful waiting" or systemic side effects through hormonal ablation. Local high-intensity focused ultrasound (HIFU), as minimal invasive tissue coagulation (85 degrees C), ablates prostatic tissue with high precision. Since April 1996, 184 patients have undergone 232 sessions of transrectal HIFU therapy (average 90 min) under spinal anesthesia at 2.25/3.0 MHz, 50 W, and a penetration depth of 25 mm. The follow-up serum prostate specific antigen (PSA) concentration, sextant biopsies, International Prostate Symptom Score (IPSS), quality of life measures (QoL), and complaint registration provide the foundation for this clinical evaluation. Follow-up sextant biopsies (an average of 1.9) showed 80% of the patients to be cancer free. In men with residual cancer, the tumor mass was reduced more than 90%. The PSA nadir in 97% was <4 ng/mL, including 61% with values <0.5 ng/mL. After primary HIFU, no severe side effects (fistula, second or third grade incontinence, rectal mucosal burns) occurred. All patients had a suprapubic tube (average 29 days), and 33% needed a transurethral debris resection averaging 7 g. They were discharged within 23 hours. According to the short-term follow-up transrectal HIFU enables minimal invasive local prostate tissue ablation with high rates of negative biopsies, low PSA nadir, and low complication rate.

The feasibility and safety of high-intensity focused ultrasound combined with low-dose external beam radiotherapy as supplemental therapy for advanced prostate cancer following hormonal therapy

“…Since then, many studies have confirmed the efficacy and safety of HIFU in the treatment of early localized PCa. 17,18 However, clinical results have shown a substantially increased ratio of biochemical recurrence and positive biopsy among the patients with high-risk or locally advanced PCa who underwent HIFU therapy. 19,20 This may have resulted from the following factors: (i) the ultrasound positioning system could not accurately demarcate the invasive margin of advanced PCa, which led to the insufficiency of treatment; and (ii) patients with high-risk or locally advanced PCa had a high risk of pelvic lymph node involvement due to the blind zone beyond target areas of HIFU treatment.…”

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

“…Moreover, our centre does not perform nerve-sparing HIFU because of the oncological risk and the likelihood of repeat treatment. 3,26,27 Repeat HIFU carries a significantly higher risk of impotency and incontinence. 28 Specific criteria have been established for repeat treatment because of the lesions occurring after a first procedure 29,30 and the HIFU treatment of localized prostate cancer T Ripert et al problems in detecting prostate boundaries for a repeat procedure.…”

Differential Gene Expression Analysis of Prostate Cancer for Biomarkers and Potential Drug Targets Identification

“…These DEGs retrieved are important for investigating the mechanism of disease development from Prostate cancer. It is well known that Prostate Cancer treatment has severe side effects, which necessitate the need to find better chemotherapeutic agents (Chaussy et al, 2001). …”