Abstract
Over the past 25 years, the average life expectancy for men has increased by 4 years, and the age of prostate cancer detection has decreased an average of 10 years with diagnosis increasingly made at early-stage disease where curative therapy is possible. These changing trends in the age and extent of malignancy at diagnosis have revealed limitations in conventional curative therapies for prostate cancer, including a significant risk of aggressive cancer recurrence, and the risk of long-term genitourinary morbidity and its detrimental impact on patient quality of life (QOL). Greater awareness of the shortcomings in radical prostatectomy, external radiotherapy and brachytherapy have prompted the search for alternative curative therapies that offer comparable rates of cancer control and less treatment-related morbidity to better preserve QOL. High intensity focused ultrasound (HIFU) possesses characteristics that make it an attractive curative therapy option. HIFU is a non-invasive approach that uses 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 prostate cancer, and is under experimental investigation for therapeutic use in renal and breast malignancies. Clinical research on HIFU therapy for localized prostate cancer began in the 1990s, and there have now been approximately 30,000 prostate cancer patients treated with HIFU, predominantly with the Ablatherm (EDAP TMS, Lyon, France) device. Transurethral resection of the prostate (TURP) has been combined with HIFU since 2000 to reduce prostate size, facilitate tissue destruction, and to minimize side effects. Advances in imaging technologies are expected to further improve the already superior efficacy and morbidity outcomes, and ongoing investigation of HIFU as a focal therapy and in salvage and palliative indications are serving to expand the role of HIFU as a highly versatile non-invasive therapy for prostate cancer.
Highlights
Knowledge that tissue destruction could be achieved with high-intensity focused ultrasound (HIFU) has been around since the 1930s, efforts to clinically implement this technology were delayed due to the absence of imaging technology to monitor the procedure [1]
Clinical research on High intensity focused ultrasound (HIFU) therapy for localized prostate cancer began in the 1990s, and there have been approximately 30,000 prostate cancer patients treated with HIFU, predominantly with the Ablatherm (EDAP TMS, Lyon, France) device
Transrectal High-Intensity Focused Ultrasound for the Treatment of Localized Prostate Cancer: Current Role the mid-late 1990s found a relationship between the coagulated prostate volume with HIFU and obstruction, and analysis of prospective studies found a high rate of urinary tract infections in this necrotic tissue
Summary
Knowledge that tissue destruction could be achieved with high-intensity focused ultrasound (HIFU) has been around since the 1930s, efforts to clinically implement this technology were delayed due to the absence of imaging technology to monitor the procedure [1]. HIFU was found to possess the effective attribute needed for cancer treatment of tissue destruction, but it was not effective in infravesical deobstruction, where obstruction was increased from shrinkage and necrotic tissue. Clinical trials of HIFU therapy for prostate cancer during. Transrectal High-Intensity Focused Ultrasound for the Treatment of Localized Prostate Cancer: Current Role the mid-late 1990s found a relationship between the coagulated prostate volume with HIFU and obstruction, and analysis of prospective studies found a high rate of urinary tract infections in this necrotic tissue. The current use of HIFU involves computers, special software, transrectal ultrasound devices and MRI to allow real-time control and monitoring during the treatment session. The validation and international acceptance of transrectal HIFU treatment of prostate cancer has been increasing as the result of the growing clinical experience and published research on HIFU. 5-year efficacy results are available [5,6], long-term cancer control data from 10-year patient follow-up await to be published
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