Prostate thermal therapy with high intensity transurethral ultrasound: The impact of pelvic bone heating on treatment delivery

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Purpose: This study was designed to assess pelvic bone temperature during typical treatment regimens of transurethral ultrasound thermal ablation of the prostate to establish guidelines for limiting bone heating.Methods: Treatment with transurethral planar, curvilinear, and sectored tubular applicators was simulated using an acoustic and biothermal pelvic model that accommodates applicator sweeping, boundary temperature control, and changes in perfusion and attenuation with thermal dose to more accurately model ultrasound energy penetration. The effects of various parameters including power and frequency (5–10 MHz) on bone heating were assessed for a range of prostate cross-sections (3–5 cm) and bone distances (1–3 cm).Results: All devices can produce significant bone heating (temperatures >50°C, thermal dose >240 EM43°C) without optimization of applied frequency or power for bone <3 cm from the prostate boundary. In small glands (∼3 cm) increasing operating frequency of curvilinear and planar devices can increase bone temperatures, whereas the tubular applicator can be used at 10 MHz to avoid likely bone damage. In larger prostates (4–5 cm wide) increasing frequency reduces bone heating but can substantially increase treatment time. Lowering power can reduce bone temperature but may increase thermal dose by increasing treatment duration. All applicators can be used to treat glands 4–5 cm with limited bone heating by selecting appropriate power and frequency.Conclusions: Pubic bone heating during ultrasound thermal therapy of the prostate can be substantial in certain situations. Successful realization of this therapy will require patient-specific treatment planning to optimally determine power and frequency in order to minimize bone heating.