Transrectal high-intensity focused ultrasound using the ablatherm device in the treatment of localized prostate carcinoma

Objectives. High-intensity focused ultrasound (HIFU) consists of focused ul trasound waves emitted from a transducer that are capable of inducing tissu e damage. The histologic effects and clinical outcome of the HIFU treatment were studied in two different groups of men with prostate carcinoma. Methods. The HIFU treatment was performed under regional or general anesthe sia with the Ablatherm device. In one group, HIFU was performed 7 to 12 day s before radical prostatectomy, and meticulous histopathologic examination of the radical prostatectomy specimens was performed, The second group cons isted of patients with localized prostate carcinoma for whom radical prosta tectomy was not an option and who received HIFU treatment alone. Results. in 14 patients treated with HIFU before radical prostatectomy, com plete necrosis was seen in the treated region in all cases. On the dorsal b order, however, incomplete destruction of tissue was noted, and in 4 cases a small vital tumor focus was seen. In the second group, of those patients in whom the entire prostate was treated, a negative biopsy result and a pro state-specific antigen (PSA) level less than 4 ng/mL was obtained in 60% an d a PSA nadir less than 0.5 ng/mL in 55% of patients. Conclusions. HIFU treatment results in the two groups clearly demonstrate t he potential of this modality in the treatment of localized prostate carcin oma. This study showed that extensive coagulative necrosis can be obtained in the treated areas; however, exact targeting is crucial and a prerequisit e for extended clinical application of HIFU. (C) 1999, Elsevier Science Inc .