Visually directed high‐intensity focused ultrasound for organ‐confined prostate cancer: a proposed standard for the conduct of therapy

Abstract

None had had previous hormone therapy and all had ≥ 3-month PSA nadirs recorded at the follow-up. Nine men were treated using an algorithm-based protocol (group 1) and 25 using visually directed therapy (group 2). The conduct of visually directed treatment was described and changes seen using B-mode US were categorized using three 'Uchida' grades. RESULTSThe mean PSA nadir achieved in group 2 was 0.15 ng/mL, vs 1.51 ng/mL in group 1 ( P < 0.005). In group 2, 21 of 25 men achieved PSA nadirs of ≤ 0.2 ng/mL 3 months after treatment. Seven men achieved undetectable PSA values. The occurrence rate of treatmentrelated toxicity was similar in both groups. CONCLUSIONVisually directed, transrectal HIFU enables clinically important and statistically significantly lower PSA nadirs to be achieved than algorithm-based HIFU. This is the first reported experience of visually directed HIFU for the treatment of organ-confined prostate cancer. We think that this is the first attempt to standardize the conduct of therapy; such standardization facilitates teaching it, and makes it possible to derive quality standards. The standardization of the conduct of therapy is a key step in the process of health technology assessment.

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

“…18 For prostate cancer, ultrasound imaging has recently been suggested and used as a noninvasive temperature monitoring system for improving treatment heating patterns with HIFU devices by adjusting the treatment parameters between pulses. 15 Regardless of the method used to monitor and control HIFU prostate thermal therapy, the heating requires significantly long treatment times for prostate cancer ͑169 min average 5 ͒. When monitoring the temperature with MR, the cost and resources involved can become significant with this long treatment.…”

“…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. 5 Magnetic resonance ͑MR͒ imaging techniques are being investigated for noninvasive monitoring of thermal therapy.…”

Prostatic cancer surveillance following whole-gland high-intensity focused ultrasound: comparison of MRI and prostate-specific antigen for detection of residual or recurrent disease

“…Although our results suggest that MRI adds little to the use of PSA in the routine monitoring of patients for residual or recurrent disease after HIFU, it has the fundamental advantage that it may be used to localise the tumour. Indeed, Rouvière et al [10] have recently shown that biopsies targeted to areas of suspicion on post-HIFU (Ablatherm device) DCE-MRI were 3.35 times more likely to be positive for tumour than untargeted cores [11].…”

“…All included patients underwent treatment using the whole-gland HIFU technique as previously described [11,12].…”

Impact of Ethnicity on Surgical Margins at Radical Prostatectomy

“…Five of the first six patients treated were failures, and this was with proctors present. We are part of the European user group and at the quarterly trial meetings, it was agreed that we should move from low power treatments to high power treatments [5], use suprapubic catheters in preference to urethral and amend bowel preparation to help prevent the chance of fistulae. All these changes were made during the trial and thus skewed the data.…”