Short‐term outcome after high‐intensity focused ultrasound in the treatment of patients with high‐risk prostate cancer

Abstract

OBJECTIVE To assess the short‐term outcome in patients with high‐risk prostate cancer treated by transrectal high‐intensity focused ultrasound (HIFU). PATIENTS AND METHODS From April 2003 to November 2004, 30 patients with high‐risk prostate cancer were enrolled in this prospective study; all had transurethral resection of the prostate before transrectal HIFU treatment, using the Ablatherm device (EDAP, Lyon, France) during the same session, associated with hormonal therapy with luteinizing hormone‐releasing hormone analogues. After the procedure, all the patients were evaluated every 3 months by physical examination, prostate‐specific antigen (PSA) assay and a continence questionnaire. The follow‐up schedule also included a transperineal prostate biopsy 6 months after the treatment. All the patients had a minimum follow‐up of 12 months. RESULTS The HIFU treatment took a median (interquartile range, IQR) of 140 (100–160) min. No complications were reported during treatment. The mean (IQR) hospitalization was 2.2 (1–4) days, and the suprapubic drainage tube was removed after 12 (7–18) days. The complications after treatment were: urinary tract infections in five patients (16%), stenosis of the intraprostatic and membranous urethra in three (10%), and secondary infravesical obstruction in four (13%). At 12 months after the procedure, 28 patients (93%) were continent. Seven of the 30 men (23%) had a positive prostate biopsy. At the 1‐year follow‐up only three of the 30 patients with high‐risk prostate cancer had a PSA level of >0.3 ng/mL. CONCLUSIONS HIFU is a modern, minimally invasive therapy for prostate cancer, often used in selected patients with localized disease. The present results show that HIFU was also feasible in patients with high‐risk prostate cancer. The low complication rates and favourable functional outcome support the planning of further larger studies in such patients. The oncological efficacy of HIFU should be assessed in further studies with a longer follow‐up.

Transurethral ultrasound applicators with dynamic multi‐sector control for prostate thermal therapy: In vivo evaluation under MR guidance

“…6,12 Cancer treatments require accurate targeted thermal dose delivery to assure destruction of the cancerous tissue, while avoiding damage to surrounding tissues ͑rectum, prostatic sphincters, neurovascular bundles͒. Transrectal high-intensity focused ultrasound ͑HIFU͒ devices offer a high degree of control over the creation of a thermal lesion in the prostate, 5,13,14 and recent advancements in ultrasound imaging-based treatment monitoring may further improve treatment results. 15 However, transrectal HIFU devices require significant treatment times to ablate large volumes and face difficulties targeting the anterior portion of the gland.…”

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

“…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. These patients had a high PSA value or Gleason score.…”

High Intensity Focused Ultrasound (Hifu) in Prostate Cancer

“…Combination of HIFU with others treatment modalities is possible: high risk cancers have been treated with a combination of HIFU and androgen deprivation therapy [ 52 ], A synergistic effect has been shown when using docetaxel in a neoadjuvant form just before HIFU in agressive tumors such as Dunning model [ 53 ].…”