Transrectal high-intensity focused ultrasound ablation of prostate cancer: effective treatment requiring accurate imaging.
Transrectal HIFU ablation has become a reasonable option for the treatment of localized prostate cancer in non-surgical patients, with 5-year disease-free survival similar to that of radiation therapy. It is also a promising salvage therapy of local recurrence after radiation therapy. These favourable results are partly due to recent improvements in prostate cancer imaging. However, further improvements are needed in patient selection, pre-operative localization of the tumor foci, assessment of the volume treated and early detection of recurrence. A better knowledge of the factors influencing the HIFU-induced tissue destruction and a better pre-operative assessment of them by imaging techniques should improve treatment outcome. Whereas prostate HIFU ablation is currently performed under transrectal ultrasound guidance, MR guidance with real-time operative monitoring of temperature will be available in the near future. If this technique will give better targeting and more uniform tissue destruction, its cost-effectiveness will have to be carefully evaluated. Finally, a recently reported synergistic effect between HIFU ablation and chemotherapy opens possibilities for treatment in high-risk or clinically advanced tumors.
Rouvière
Olivier
O
Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Pavillon P Radio, Hôpital Edouard Herriot, F-69437 Lyon cedex 03, France. Olivier.rouviere@netcourrier.com
Souchon
Rémi
R
Salomir
Rarès
R
Gelet
Albert
A
Chapelon
Jean-Yves
JY
Lyonnet
Denis
D
D003952:Diagnostic Imaging; D018450:Disease Progression; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D018579:Patient Selection; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy*; D016879:Salvage Therapy; D036761:Ultrasound, High-Intensity Focused, Transrectal