Robotic High-intensity Focused Ultrasound for Prostate Cancer: What Have We Learned in 15 Years of Clinical Use?

Chaussy, C.; Thüroff, S.

doi:10.1007/s11934-011-0184-2

Cited by 19 publications

(16 citation statements)

References 41 publications

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“…In all, 33 full reports addressing HIFU for prostate cancer that fulfilled our selection criteria were selected. Of those studies, 31 examined the efficacy of HIFU as the primary treatment [52–82], being administered using the Ablatherm [68–84] and Sonablate [85–98] devices in 17 and 14 studies respectively. Two studies examined the efficacy of HIFU as salvage treatment for local recurrence after EBRT [99,100].…”

Section: Resultsmentioning

confidence: 99%

“…During the past 15 years, over 30 000 prostate HIFU treatments have been performed, mainly in Europe, but also throughout the world, including the USA (under an investigational device -exemption protocol, approved by the USA Food and Drug Administration) [ 53 ] . Two devices are currently available for the treatment of prostate cancer: Ablatherm ® (EDAP-TMS SA, Vaulx en Velin, France) and Sonablate ® (Focus surgery, Indianapolis, IN, USA).…”

Section: Hifu For Prostate Cancer: Technical Features and Proceduresmentioning

confidence: 99%

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High‐intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer

et al. 2012

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What's known on the subject? and What does the study add? Novel therapeutic methods have emerged in recent years as ‘focal’ treatment alternatives in which cancer foci can be eradicated and greatly reducing the associated side‐effects of radical treatment. High‐intensity focused ultrasound (HIFU) seems to result in a well fitted technology, which has proven short‐ to medium‐term cancer control, with a low rate of complications comparable with those of established therapies. This is an up‐to‐date review of the available literature on HIFU as a definitive treatment of prostate cancer. It describes the technique in a comprehensive approach in terms of technical features, procedure, indications, and gives an overview of its historical background; finally, we present the future applications of HIFU and its development trend. OBJECTIVES To provide an up‐to‐date review of the available literature on high‐intensity focused ultrasound (HIFU) as a definitive treatment of prostate cancer. To present the technique in a comprehensive approach, comparing the available devices according to the existing evidence in terms of technical features, procedure, indications, and to give an overview of its historical background; and finally, to discuss future applications of HIFU and its development trend. MATERIALS AND METHODS A systematic literature search was conducted using MEDLINE and EMBASE via Ovid databases (January 2000 to December 2011), to identify studies on HIFU for treatment of prostate cancer. Only English‐language and human‐based full manuscripts that reported on case series studies with >50 participants, patient characteristics, efficacy and safety data were included. RESULTS No randomised controlled trials were identified by the literature search. We identified 31 uncontrolled studies that examined the efficacy of HIFU as primary treatment and two studies that examined the efficacy of HIFU as salvage treatment. Most treated patients had localised prostate cancer (stage T1–T2); Gleason scores of 2–10 and mean prostate specific antigen (PSA) values of 4.6–12.7 ng/mL. The mean age range of the patients was 64.1–72 years. The mean follow‐up ranged from 6.4 to 76.8 months. Negative biopsy rates ranged from 35 to 95%. PSA nadirs ranged from 0.04 to 1.8 ng/mL. The 5‐year disease‐free survival rates ranged from 61.2 to 95%; 7‐ and 8‐year disease free survival rates ranged from 69 to 84%. The most common complications associated with the HIFU procedure as the primary treatment included: urinary retention (<1–20%); urinary tract infections (1.8–47.9%); stress or urinary incontinence (<1–34.3%); and erectile dysfunction (20–81.6%). Recto‐urethral fistula was reported in <2% of patients. Treatment‐related morbidity appeared to be reduced by the combination of transurethral resection (TURP) of the prostate and HIFU. CONCLUSIONS Novel therapeutic methods have emerged in recent years as ‘focal’ treatment alternatives, in which cancer foci could be eradicated by greatly reducing the associated side‐effects of radical treatment. ...

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Section: Resultsmentioning

confidence: 99%

Section: Hifu For Prostate Cancer: Technical Features and Proceduresmentioning

confidence: 99%

High‐intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer

et al. 2012

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“…Regarding postoperative micturition and continence, IPSS and uroflowmetry data did not change after HIFU treatment. Previous studies could show, that combining TURP and HIFU is mandatory to reduce postoperative voiding dysfunction [21]. However, even previous TURP cannot reduce infravesical obstruction completely.…”

Section: Discussionmentioning

confidence: 99%

Quality of life and functional outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer

et al. 2017

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BackgroundTo evaluate quality of life, functional and oncological outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer.MethodsOne hundred thirty-one patients, treated with TURP and HIFU in a single institution were followed up for oncological and functional outcome. Oncological outcome was quantified by biochemical recurrence free survival using the Stuttgart and Phoenix criteria. Quality of life was assessed by usage of standardized QLQ-C30 and QLQ-PR25 questionnaires. In addition, functional questionnaires such as IPSS and IIEF-5 were used. Complications were assessed by the Clavien-Dindo classification.ResultsOne hundred thirty-one patients with a mean age of 72.8 years (SD: 6.0) underwent HIFU for prostate cancer (29.0% low risk, 58.8% intermediate risk, 12.2% high risk). PSA nadir was 0.6 ng/ml (SD: 1.2) after a mean of 4.6 months (SD: 5.7). Biochemical recurrence free survival defined by Stuttgart criteria was 73.7%, 84.4% and 62.5% for low-, intermediate- and high-risk patients after 22.2 months. Complications were grouped according to Clavien-Dindo and occurred in 10.7% (grade II) and 11.5% (grade IIIa) of cases. 35.1% of patients needed further treatment for bladder neck stricture. Regarding incontinence, 14.3%, 2.9% and 0% of patients had de novo urinary incontinence grade I°, II° and III° and 3.8% urge incontinence due to HIFU treatment. Patients were asked for the ability to have intercourse: 15.8%, 58.6% and 66.7% of patients after non-, onesided and bothsided nervesparing procedure were able to obtain sufficient erection for intercourse, respectively. Regarding quality of life, mean global health score according to QLQ-C30 was 69.4%.ConclusionHIFU treatment for localized prostate cancer shows acceptable oncological safety. Quality of life after HIFU is better than in the general population and ranges within those of standard treatment options compared to literature. HIFU seems a safe valuable treatment alternative for patients not suitable for standard treatment.

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“…The focused ultrasound waves of HIFU are capable of inducing sharp increases in temperature (around 70˚C to 100˚C) in a few seconds. During the clinical use of HIFU, the tissue-sensitive adjacent structures such as the rectum, external sphincter, and the neurovascular bundles are spared from destruction due to the steep temperature gradient between the focal tissue and surrounding region [8,9].…”

Section: Thermalmentioning

confidence: 99%

Transrectal High-Intensity Focused Ultrasound for the Treatment of Localized Prostate Cancer: Current Role

Chaussy¹,

Tilki²,

Thüroff³

2013

JCT

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Over the past 25 years, the average life expectancy for men has increased by 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 quality of life (QOL). Greater awareness of the shortcomings in radical prostatectomy, external radiotherapy and brachytherapy have 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 non-invasive approach that uses precisely-delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of prostate cancer, and is under experimental investigation for therapeutic use in renal and breast malignancies. Clinical research on HIFU therapy for localized prostate cancer began in the 1990s, and there have now been approximately 30,000 prostate cancer patients treated with HIFU, predominantly with the Ablatherm (EDAP TMS, Lyon, France) device. Transurethral resection of the prostate (TURP) 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 and in salvage and palliative indications are serving to expand the role of HIFU as a highly versatile non-invasive therapy for prostate cancer.

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Robotic High-intensity Focused Ultrasound for Prostate Cancer: What Have We Learned in 15 Years of Clinical Use?

Cited by 19 publications

References 41 publications

High‐intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer

High‐intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer

Quality of life and functional outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer

Transrectal High-Intensity Focused Ultrasound for the Treatment of Localized Prostate Cancer: Current Role

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