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Hifu Prostate
Hifu Prostate
doi:10.1093/jjco/hym173
area, thereby inducing coagulation necrosis without causing determined based on the results of digital rectal examination,
damage to the tissue in the path of the ultrasound beam multi-regional transrectal ultrasound-guided biopsy more
(5,6). The first clinical application of HIFU was done by than 12 cores and preoperative pelvic MRI. We ablated the
Gelet et al. (7) in the treatment of organ-confined prostate peripheral zone of both lobes and the ipsilateral transitional
cancer. Currently, two HIFU devices are available: zone upon the patients’ consent when it was likely that the
Ablatherm HIFU device (EDAP SA, Lyon, France) and signature cancers were localized in one lobe (focal therapy).
Sonablatew 500 (Focus surgery, IN, USA). The efficacy and Otherwise, the whole organ was ablated with HIFU (Fig. 1).
safety of Ablatherm HIFU device for the treatment of loca- The patients were discharged on the next day after the
lized prostate cancer has been established (7 – 14). The HIFU.
Sonablatew 500 was introduced in Japan in 1999. The advan-
tage of this device is that one can monitor the prostate in
FOLLOW-UP
situ with ultrasonography during treatment (15,16). Uchida
et al. (15) reported an overall biochemical disease-free rate Scheduled biopsies were done 6 and 12 months after treat-
of 75% in 47 patients following Sonablatew 500 treatment. ment. During the follow-up period, PSA was measured at 3,
Prostate cancer has been recognized to be a multifocal 6, 12, 18, 24 and 36 months. Serum PSA was analyzed with
disease (17). However, the current evidence suggests that the chemiluminescent enzyme-linked immunoassay (normal
Figure 1. The shaded portion indicates the ablative area. Open circle: urethral preservation. (a) Whole therapy: the whole organ was ablated with high-
intensity-focused ultrasound (HIFU) without urethra. (b) Focal therapy: when multi-regional biopsies more than 12 cores revealed the localization of cancers
in one lobe, the ipsilateral transitional zone and the peripheral zone of both lobes were ablated without urethra.
mean number of positive cores at diagnosis based on a pros- 2.74 + 2.69 ng/ml, P ¼ 0.0066; at 24 months, 3.05 +
Table 1. Patient characteristics Table 2. Total prostate volume and transitional zone volume before and
after HIFU therapy
Total Whole therapy Focal therapy P
Whole Focal P value
Number of 70 41 (58.6) 29 (41.4)
patients (%) Total prostate
volume (ml)
Age (years)
Pre-HIFU 31.0 + 14.0 35.8 + 11.4 0.1902
Median 72 73 72 0.45
6 months 17.2 + 6.7 26.9 + 13.1 0.0008
Range 61–80 61–79 62– 80
12 months 15.5 + 6.7 30.3 + 16.2 0.0001
Follow-up periods
(M) Transitional zone
volume (ml)
Median 34 37 32 0.66
Pre-HIFU 14.2 + 8.0 14.8 + 6.3 0.7548
Range 8 –45 8– 44 9 –45
6 months 7.0 + 3.1 13.1 + 8.8 0.0008
PSA at diagnosis
(ng/ml) 12 months 7.2 + 3.7 14.7 + 7.8 0.0001
Median 6.8 7.0 5.4 0.29
Pre-operative
Gleason score (%) Total Whole Focal P value
efficacy can be observed for all therapies with increasing biopsy core at diagnosis and prostate volume) that correlate
disease risk (20 – 24,26,28 – 31). Correspondingly, in this with unifocal disease. The use of some parameters to corre-
study, the 2-year biochemical DFS rates after HIFU in late with unifocal disease may need to establish the focal
patients at high risk were significantly inferior than those in therapy to localized prostate cancer.
patients at low risk. Marberger (32) reported if an adequate In our results, the total volume and the transitional zone
PSA nadir is not reached within 3 – 4 months, curative volume of the prostate were not changed after focal therapy
therapy is probably failing and repeat HIFU or a change in in spite of decreasing PSA levels. Sequential anatomical
therapy should be considered. From our results, for patients imaging showed that a gradual shrinkage of treated volumes
with intermediate-risk prostate cancer, combination therapy occurred by the whole therapy, which indicates the replace-
of HIFU and other modalities (e.g. hormone therapy) should ment of the necrotic region with fibrous scar tissue. A pre-
be considered. But for patients with high-risk prostate vious report showed the size of the gland decreased after
cancer, HIFU monotherapy did not result in satisfactory HIFU to a 41% of the initial size (8). Since the contralateral
cancer control. transitional zone was not ablated in focal therapy group,
Previous reports have shown that the negative biopsy rates these areas might have been spared for the circulation, and
after HIFU treatment based on sextant core biopsies ranged hence, maintained its size.
from 75 to 93% (8,9,11,15). In our study, since the time It is still debatable whether PSA is the adequate measure
it might be beneficial since it can maintain testosterone 7. Gelet A, Chapelon JY, Bouvier R, Pangaud C, Lasne Y. Local control
of prostate cancer by transrectal high intensity focused ultrasound
level. It has been known that the radiation therapy for pros- therapy: preliminary results. J Urol 1999;161:156– 62.
tate cancer causes a transient decline in serum testosterone 8. Blana A, Walter B, Rogenhofer S, Wieland WF. High-Intensity focused
levels (42). This decline in testosterone levels after radiation ultrasound for the treatment of localized prostate cancer: 5-year
has been attributed to the scatter effect of the radiation on experience. Urology 2004;63:297–300.
9. Gelet A, Chapelon JY, Bouvier R, Rouviere O, Lyonnet D, Dubernard JM.
the testis. However, since whole but not focal therapy with Transrectal high-intensity focused ultrasound for the treatment of localized
HIFU affected the serum androgen levels, this decline in prostate cancer: factors influencing the outcome. Eur Urol 2001;40:124–9.
serum androgen levels might not represent damage to the 10. Vallancien G, Prapotnich D, Cathelineau X, Baumert H, Rozet F.
Transrectal focused ultrasound combined with transurethral resection of
testis, but rather indicate that the destruction of a large the prostate for the treatment of localized prostate cancer: feasibility
number of prostatic cells could have a negative feedback on study. J Urol 2004;171:2265– 7.
testicular function. To our knowledge, this is the first report 11. Thuroff S, Chaussy C, Vallancien G, Wieland W, Kiel HJ, Le Duc A,
et al. High-intensity focused ultrasound and localized prostate cancer:
about the effect of whole, but not focal, therapy on the efficacy results from the European multicentric study. J Endourol
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high-intensity focused ultrasound for urologic cancers. Nat Clin Pract
lowing whole therapy subsequently recover, as is seen fol- Urol 2005;2:191 –8.
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