High-intensive focused ultrasound in localized prostate cancer

Background and Purpose: The results of the standard treatment for prostate cancer-radical prostatectomy-are not entirely satisfactory. A new local the rapy, transrectal high-intensive focused ultrasound (HIFU), has been develo ped, We reviewed our experience with HIFU for palliation of localized prost ate cancer. Patients and Methods: Our series included 65 men with confirmed prostate ca ncer without detectable metastases who were not suitable candidates for rad ical prostatectomy, After prophylactic suprapubic cystostomy, the patients were treated using the Ablatherm version 2.32 under spinal anesthesia. The effects were monitored by serum prostate specific antigen assays, digital r ectal examination, and biopsy. The mean follow-up is 10 months (range 1-18 months). Results: There were no intraoperative or postoperative deaths, and there ha ve been no deaths from prostate cancer. Residual cancer was detected in 35% of the patients in whom only biopsy-positive portions of the prostate were treated and 17% of those in whom the entire gland was treated. Retreatment was performed 1 month after the first session in these patients. The prost ate volume increased an average of 30% after treatment, but by 3 months, th e gland was 10% to 20% smaller than its original size, Three patients suffe red complications secondary to overheating of the rectal wall or treatment too close to the external urethral sphincter. Conclusion: The low morbidity, minimal invasiveness, avoidance of systemic side effects, and potentially curative effect make HIFU a potentially usefu l option for the treatment of localized prostate cancer.