Extracorporeal application of high-intensity focused ultrasound for prostatic tissue ablation (original) (raw)
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Ultrasonics Sonochemistry, 1997
In a phase-I clinical trial the morphologic impact and safety of high-intensity focused ultrasound (HIFU) administered transrectally for tissue ablation in human prostates (n = 54) was evaluated. Location and size of the tissue lesions correlated well with the predefined target area and revealed sharply delineated coagulative necrosis in all cases. Intervening tissues, such as the rectal wall and posterior prostate capsule were invariably intact. In a subsequent phase-II clinical trial safety and efficacy of transrectal HIFU as a novel minimally invasive treatment modality for patients with symptomatic benign prostatic hyperplasia (BPH; n = 102) was determined. The maximum urinary flow rate (Q .... ml/s) increased from 9.1 + 4.0 to 12.9 _+ 6.1 (3 months, n = 86), 12.7_ 5.1 (6 months, n = 78) and 13.3 _+ 6.1 (12 months, n = 56). In the same time period the post void residual volume (ml) decreased from 131 _+ 115 to 46 +45, 57 +46 and 48_+ 36 and the AUA symptom score decreased from 24.5 +_4.7 to 13.3_+4.4, 13.4 +4.7 and 10.8-+2.5. A subset of patients (n = 30) underwent multichannel pressure flow studies, which demonstrated that transrectal HIFU reduces bladder outflow obstruction. These data demonstrate that transrectal HIFU is capable of inducing coagulative necrosis in the human prostate via a transrectal approach while preserving intervening and adjacent tissue. A 48% improvement of uroflow and a 53% decrease of urinary symptoms 1 year after treatment prove that transrectal HIFU is an effective and safe minimally invasive treatment option for BPH. © 1997 Elsevier Science B.V.
High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment
Polish Journal of Radiology, 2015
Background: High-intensity focused ultrasound (HIFU) applies high-intensity focused ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation. This study intended to review HIFU to explain the fundamentals of HIFU, evaluate the evidence concerning the role of HIFU in the treatment of prostate cancer (PC), review the technologies used to perform HIFU and the published clinical literature regarding the procedure as a primary treatment for PC. Material/Methods: Studies addressing HIFU in localized PC were identified in a search of internet scientific databases. The analysis of outcomes was limited to journal articles written in English and published between 2000 and 2013. Results: HIFU is a non-invasive approach that uses a 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 PC. Clinical research on HIFU therapy for localized PC began in the 1990s, and the majority of PC patients were treated with the Ablatherm device. Conclusions: HIFU treatment for localized PC can be considered as an alternative minimally invasive therapeutic modality for patients who are not candidates for radical prostatectomy. Patients with lower pre-HIFU PSA level and favourable pathologic Gleason score seem to present better oncologic outcomes. Future advances in technology and safety will undoubtedly expand the HIFU role in this indication as more of patient series are published, with a longer follow-up period.
High-intensity Focused Ultrasound (HIFU) in the Treatment of Benign Prostatic Hyperplasia (BPH)
The Keio Journal of Medicine, 1995
Transurethral resection of the prostate (TURF) and open adenectomy are regarded the golden standard in the management of patients with symptomatic benign prostatic hyperplasia (BPH). Various alternative treatment forms (microwaves, laser, radiofrequency, focused ultrasound) have been introduced recently. They all aim at reduction of morbidity related to TURP keeping a comparable efficacy at the same time. Since December 1992, 50 patients with BPH have been treated by high intensity focused ultrasound (HIFU-P) at our department. Six weeks following HIFU-P mean Qmax improved from 5.7ml/s to 11.6ml/s. Post voiding residual volume (RV) dropped from 215ml to 100ml, the International Prostate Symptom Score (IPSS) from 19.8 to 9.9. Both, IPSS and RV further improved during the following weeks. Follow-up data one year after treatment demonstrate that results remained stable in the majority of patients. Urinary tract infections were observed in 3 patients, macrohematospermia in all and macro hematuria (caused by the suprapubic catheter) requiring blood transfusion in 1 patient.
Clinical Imaging, 2008
High-intensity focused ultrasound (HIFU) delivers ultrasound energy via a transrectal probe to produce rapid thermal necrosis of prostate tissue in the focal region without damaging the surrounding tissue. Since 1992, we have been treating prostate diseases-both benign and malignant with HIFU. In this study our main objectives were to evaluate efficacy and safety of the HIFU for the treatment of T1b-2N0M0 stage prostate cancer (PCa). We performed over 100 HIFU treatments in 84 patients with biopsy-proven localized prostate cancer using the Sonablate TM HIFU device. We present data on 49 (62 HIFU sessions) patients who underwent six months follow-up and postoperative biopsy. Demographics of these patients are (mean ± SD): age 71.9 ± 6.9 years, prostate volume 27.6 ± 11.6 ml, PSA 17.74 ± 17.9 ng/ml. Gleason scores: 2-4, 5-7 and 8-9 in 14, 30 and 9 patients respectively. 34, 11 and 1 patient received one, two and three HIFU treatment sessions respectively. A mean operating time was 2 hrs 47 min (55-356 min). All patients were treated under epidural anesthesia. Patients were followed with sextant biopsies and serum PSA. The clinical outcome of 49 patients followed for at least 6 months (mean 16.7 ± 16.4 months) is as follows. Complete Response (CR -defined as negative biopsy and PSA velocity of < 0.75 ng / ml of three successive readings) was observed in 95 %, 80%, 40 % and 0% for the patients who had preoperative PSA level (ng/ml) of less then 10, 20, 30 and higher respectively. PSA results were strongly correlated to the completeness of the HIFU treatment. One earlier patient treated with the Sonablate-200 device developed a rectourethral fistula and 10 patients developed a urethral stricture. Our follow-up would suggest that transrectal HIFU therapy can be used safely to ablate localized prostate cancer with minimal adverse events with a relatively high CR rate and the ability to deliver repeated HIFU treatments without added toxicity. This will allow for repeated HIFU therapy for treatment failures. Additional follow-up continues to confirm the long -term durability of treatment.
High Intensity Focussed Ultrasound Therapy for Prostatic Tumors: Anaesthesiologists Perspective
Journal of Anesthesia & Intensive Care Medicine, 2016
Introduction Ultrasound guided epidural anaesthesia, regional blocks, internal jugular vein cannulations, ultrasound lithotripsy and ultrasound assisted thrombolytsis are some of the current medical applications of ultrasound technology [1,2]. Low-intensity ultrasound produces physiological effects such as stimulation of bone-growth, and has the potential to temporarily disrupt the blood-brain barrier for drug delivery. High intensity focussed ultrasound (HIFU) which causes thermal ablation of diseased tissue via intense heat generation locally is the latest promising advancement in minimally invasive surgery with the potential to revolutionize carcinoma prostate therapy [1,3-5]. It was approved by the FDA in the year 2004. When Magnetic Resonance Imaging (MRI) is used for guidance, the technique is called Magnetic Resonance guided Focused Ultrasound (MRgFUS/ MRgHIFU). HIFU generally uses lower frequencies (0.250 to 2 MHz) than medical diagnostic ultrasound (7-14MHz), but at considerably higher energies. HIFU cannot penetrate air or solid bone and hence a Tran rectal ultrasound probe is used to access the prostate
Prostate cancer therapy with high-intensity focused ultrasound
Clinical genitourinary cancer, 2005
High-intensity focused ultrasound (HIFU) has been used to ablate benign and malignant prostate tissue for several decades. This review summarizes the technology and available clinical trials to date. Continued technological advances combined with well-designed clinical trials could allow HIFU to become part of the arsenal against prostate cancer.
The Journal of Urology, 2007
We examined the safety and potential efficacy of transrectally delivered high intensity focused ultrasound for the full gland ablation of previously untreated localized prostate cancer. Materials and Methods: A total of 20 patients with localized prostate cancer underwent 1 to 3 high intensity focused ultrasound treatments of the prostate. The primary outcome was safety and the secondary outcomes were prostate specific antigen, prostate biopsy and quality of life measures. Results: A total of 19 patients had complete followup. Serious adverse events related to treatment were limited with the most common adverse event being transient urinary retention more than 30 days in duration in only 10% of patients. Rectal injury occurred in 1 patient. With 1 to 3 treatments 42% of the patients achieved prostate specific antigen less than 0.5 ng/ml and a negative prostate biopsy. Conclusions: High intensity focused ultrasound in patients with previously untreated prostate cancer is generally well tolerated and it has the potential to completely ablate the prostate gland. With further refinement of the optimal treatment dose and technique this technology has the potential to be an effective form of therapy for localized prostate cancer.