{"product_id":"high-intensity-focused-ultrasound-hifu-for-prostate-cancer-a-comprehensive-patients-guide","title":"High-Intensity Focused Ultrasound (HIFU) for Prostate Cancer: A Comprehensive Patient's Guide","description":"\u003cp\u003eHigh-intensity focused ultrasound (HIFU) is a noninvasive technology that uses precisely delivered ultrasound energy to destroy prostate cancer cells without radiation or surgical incisions. This review article, authored by Dr. Christian G. Chaussy and Dr. Stefan Thüroff, examines the clinical history, mechanisms, efficacy, and expanding role of HIFU in treating prostate cancer, noting that over 65,000 patients have been treated with this technology, predominantly using the Ablatherm device. The authors report that HIFU offers cancer control rates comparable to surgery and radiation therapy while significantly reducing treatment-related side effects, and they highlight its versatility across primary, salvage, focal, and palliative treatment settings. Importantly, the review emphasizes that HIFU can be repeated in cases of local recurrence—an option not available with other treatment modalities—and that ongoing improvements in imaging are expected to further enhance its precision and outcomes.\u003c\/p\u003e\n\n\u003ch1\u003eHigh-Intensity Focused Ultrasound (HIFU) for Prostate Cancer: A Comprehensive Patient's Guide\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#history\"\u003eThe Clinical History of HIFU\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#mechanisms\"\u003eHow HIFU Works: Mechanisms and Technology\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#indications\"\u003eWho Can Be Treated with HIFU?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#turp\"\u003eCombining TURP and HIFU\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#efficacy\"\u003eEfficacy of HIFU as Primary Therapy\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#morbidity\"\u003eHIFU-Related Side Effects and Morbidity\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#advanced\"\u003eHIFU in Advanced and Hormone-Resistant Disease\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#salvage\"\u003eHIFU as Salvage Therapy\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#focal\"\u003eFocal and Partial HIFU Therapy\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#immune\"\u003eImmunologic Response with HIFU\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#future\"\u003eFuture Directions of HIFU\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#conclusion\"\u003eConclusion\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eHIFU is a noninvasive treatment for prostate cancer using focused ultrasound to destroy cancer cells without surgery or radiation.\u003c\/li\u003e\n\u003cli\u003eHIFU offers cancer control rates comparable to surgery and radiation, with fewer side effects like incontinence and erectile dysfunction.\u003c\/li\u003e\n\u003cli\u003eHIFU can be repeated if cancer recurs, unlike other treatments, and can be used as salvage therapy after radiation or surgery.\u003c\/li\u003e\n\u003cli\u003eCombining HIFU with TURP reduces side effects and allows treatment of larger prostates.\u003c\/li\u003e\n\u003cli\u003eLong-term studies show 10-year cancer-specific survival rates of 92-100% depending on risk group.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why This Research Matters\u003c\/h2\u003e\n\n\u003cp\u003eOver the past 25 years, the average life expectancy for men has increased by almost 4 years. At the same time, the average age of prostate cancer detection has decreased by 10 years, with diagnosis increasingly made at early-stage disease where curative therapy is possible.\u003c\/p\u003e\n\n\u003cp\u003eThese changing trends have revealed significant limitations in conventional curative therapies for prostate cancer. Traditional treatments such as radical prostatectomy (complete surgical removal of the prostate), external beam radiotherapy, and brachytherapy (internal radiation seeds) carry a significant risk of aggressive cancer recurrence. They also pose risks of long-term genitourinary morbidity—problems with urination and sexual function—that can have a detrimental impact on a patient's quality of life.\u003c\/p\u003e\n\n\u003cp\u003eGreater awareness of these shortcomings has prompted the search for alternative curative therapies that offer comparable rates of cancer control with less treatment-related morbidity. High-intensity focused ultrasound (HIFU) possesses characteristics that make it an attractive curative therapy option. This review, published in the \u003cem\u003eJournal of Endourology\u003c\/em\u003e, examines the evidence for HIFU across the full spectrum of prostate cancer care.\u003c\/p\u003e\n\n\u003ch2 id=\"history\"\u003eThe Clinical History of HIFU\u003c\/h2\u003e\n\n\u003cp\u003eClinical trials of high-intensity focused ultrasound began in the early 1990s in Europe, Japan, and the United States. Initially, HIFU was evaluated as a therapy for benign prostatic hyperplasia (enlarged prostate). The technology demonstrated safety and efficacy through the precise destruction of local tissue.\u003c\/p\u003e\n\n\u003cp\u003eResearchers also observed that HIFU induced a significant shrinkage process within the treated organ, which led to therapy-related side effects. Specifically, early clinical trials found a relationship between the coagulated (destroyed) prostate volume and urinary obstruction. Analysis of prospective studies also found a high rate of urinary tract infections in the necrotic (dead) tissue.\u003c\/p\u003e\n\n\u003cp\u003eAs a result of the association between HIFU and obstruction, and consistent with the whole-gland concept of therapy, HIFU has been routinely combined with a neoadjuvant transurethral resection of the prostate (TURP) since 2000. TURP is a procedure that removes part of the prostate through the urethra. This combination is used to debulk the tumor mass and radically resect the middle lobes, calcifications, abscesses, and bladder neck.\u003c\/p\u003e\n\n\u003ch2 id=\"mechanisms\"\u003eHow HIFU Works: Mechanisms and Technology\u003c\/h2\u003e\n\n\u003cp\u003eThe first reported use of HIFU in local tissue destruction was made in 1944 by Lynn and Putman. The use of high-energy parabolic-focused ultrasound results in mechanical alteration and changes in the biologic structure of targeted cells. During the application of focused ultrasound, two different physical mechanisms account for its treatment effect: thermal and mechanical.\u003c\/p\u003e\n\n\u003ch3\u003eThermal Effects\u003c\/h3\u003e\n\n\u003cp\u003eThe ultrasound energy produced by HIFU is absorbed by the targeted tissue and converted into heat. The extent of temperature increase in the tissue depends on the absorption coefficient of the tissue, and the size, shape, and temperature sensitivity of the heated area. Biologic changes caused by the heating depend on the temperature level and duration of exposure.\u003c\/p\u003e\n\n\u003cp\u003eA \"thermal dose\" that exceeds a certain threshold causes tissue coagulation and leads to irreversible tissue damage through coagulative necrosis (cell death). The focused ultrasound waves of HIFU are capable of inducing sharp increases in temperature—around 70°C to 100°C (160°F to 210°F)—in just a few seconds.\u003c\/p\u003e\n\n\u003cp\u003eDuring the clinical use of HIFU, tissue-sensitive adjacent structures such as the rectum, external sphincter (the muscle that controls urination), and the neurovascular bundles (nerves important for erectile function) are spared from destruction due to the steep temperature gradient between the focal tissue and the surrounding region.\u003c\/p\u003e\n\n\u003ch3\u003eMechanical Effects\u003c\/h3\u003e\n\n\u003cp\u003eThe mechanical effects of HIFU are induced by the effects of negative pressure of the ultrasound wave on the targeted tissue. This negative pressure causes bubbles to form inside the targeted cells, which increase in size to the point at which resonance is achieved. High pressure of 20,000 to 30,000 bars develops when these bubbles suddenly collapse, causing damage to nearby cells.\u003c\/p\u003e\n\n\u003cp\u003eThe primary single lesions created by HIFU are small—measuring 1.7 × 19–26 mm—and produce reproducible volumes of sharply demarcated ablation. The small volume of tissue destroyed by a single burst of ultrasound is termed the elementary or primary lesion. To create larger lesions, several elementary lesions are made side by side by adding multiple lesion targets to the algorithm, either by mechanically moving the transducer or by electronically positioning the focal point if a phased array is available.\u003c\/p\u003e\n\n\u003ch3\u003eExperimental Identification of Clinical Parameters\u003c\/h3\u003e\n\n\u003cp\u003eIn vitro (test tube), in vivo (living organism), and computer simulation studies were conducted to identify and refine the ultrasound parameters required for the clinical treatment of prostatic disease. The destruction of tumors with HIFU in these studies provided evidence that cancerous tissues can be destroyed by HIFU without inducing metastases (spread of cancer), and that prostatic tissue can be effectively targeted through transrectal delivery of HIFU.\u003c\/p\u003e\n\n\u003ch2 id=\"indications\"\u003eWho Can Be Treated with HIFU?\u003c\/h2\u003e\n\n\u003cp\u003eThe most widespread use of HIFU, and initially the only indication for its use, has been in patients with localized prostate cancer (stage T1–2N0M0; Gleason sum ≤6) who are not candidates for surgery because of age, general health status, a prohibiting comorbidity (other medical condition), or a preference not to undergo a radical prostatectomy.\u003c\/p\u003e\n\n\u003cp\u003eHowever, with the accumulation of clinical experience and expansion of research protocols, these indications have broadened to include:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePartial therapy\u003c\/strong\u003e in unilateral low-volume, low-grade tumors (T1–2aNx\/0M0; PSA ≤20 ng\/mL)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSalvage therapy\u003c\/strong\u003e in recurrent prostate cancer following radical prostatectomy, radiation therapy, or hormone ablation (all TNx\/0M0; all Gleason scores\/PSA)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAdvanced prostate cancer\u003c\/strong\u003e as an additional neoadjuvant debulking process (T3–4Nx\/0M0; all Gleason scores\/PSA)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCastration-resistant prostate cancer\u003c\/strong\u003e (CRPCa), which is cancer that continues to grow despite hormone therapy\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe diagnosis of prostate cancer is based on the histopathologic (microscopic) examination of biopsies in cases of suspicious PSA findings, digital rectal examination, magnetic resonance imaging (MRI), transrectal ultrasound (TRUS), or unexpected findings in resected tissue after open adenomectomy, holmium laser, or transurethral resection.\u003c\/p\u003e\n\n\u003ch2 id=\"turp\"\u003eCombining TURP and HIFU\u003c\/h2\u003e\n\n\u003cp\u003eThe use of neoadjuvant TURP with HIFU became routine practice in 2000 as a means to reduce post-HIFU urethral sloughing (shedding of dead tissue) and obstruction. The combined procedure offers several other advantages over HIFU alone.\u003c\/p\u003e\n\n\u003cp\u003ePerforming TURP before HIFU in patients with localized prostate cancer allows the instant removal of any reflecting or deviating calcifications of the transitional zone that would prevent HIFU treatment, as well as abscesses, intravesical middle lobes, and large (\u0026gt;30 cc) adenomas.\u003c\/p\u003e\n\n\u003cp\u003eThe generation of a cavity and its subsequent compression by the rectal balloon increases the accessibility of the HIFU waves to the remaining gland. This approach fixes the residual prostate behind the symphysis (a joint in the pelvis), avoids movement artifacts, and allows the complete treatment of the peripheral zone in a single HIFU session.\u003c\/p\u003e\n\n\u003cp\u003eThe penetration depth of the Ablatherm Integrated Imaging device is a maximum of 26 mm. Without a TURP, total gland ablation of a larger gland (\u0026gt;30 cc) is not possible. TURP decreases the size of each prostate gland to approximately 25 mL, eliminating size restriction with HIFU. The increase of invasiveness by neoadjuvant TURP is compensated clearly by the beneficial effect in regard to higher efficacy and lower side effects; furthermore, it expanded the indication range for HIFU.\u003c\/p\u003e\n\n\u003ch2 id=\"efficacy\"\u003eEfficacy of HIFU as Primary Therapy\u003c\/h2\u003e\n\n\u003ch3\u003eEfficacy in Localized Disease\u003c\/h3\u003e\n\n\u003cp\u003eSimilar to efficacy studies with external beam radiotherapy (EBRT), brachytherapy, and cryoablation (freezing therapy), biochemical markers (PSA levels) and biopsy findings have been used as indicators of long-term cancer control with HIFU. To date, there is no universal consensus on the definition of biochemical failure in patients treated with HIFU.\u003c\/p\u003e\n\n\u003cp\u003eWith ongoing refinements in execution and outcome measurement, the efficacy of HIFU in locally confined prostate cancer is now comparable to those of radiotherapy and radical prostatectomy. According to the CaPSURE database (a large national prostate cancer registry), these conventional treatments are characterized by failure rates of 63% at a mean of 38 months post-treatment for radiotherapy, and 30% at a mean of 34 months post-treatment for radical prostatectomy.\u003c\/p\u003e\n\n\u003cp\u003eMultiple studies have documented the effectiveness of HIFU as primary therapy. Here are the key results from major clinical trials:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eChaussy and Thüroff (2002):\u003c\/strong\u003e 481 patients with stage T1–2 disease, median follow-up of 27 months. Negative biopsy rate of 86.2%, with 87.4% survival at 5 years.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eGelet et al. (2002):\u003c\/strong\u003e 102 patients with stage T1–2 disease, mean follow-up of 19 months. Negative biopsy rate of 86%, with 66% disease-free survival at 5 years.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePoissonnier et al. (2003):\u003c\/strong\u003e 120 patients with stage T1–2 disease, mean follow-up of 27 months. Negative biopsy rate of 86.2%, with 67.9% survival at 5 years.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eThüroff et al. (2003):\u003c\/strong\u003e 402 patients with stage T1–2 disease, mean follow-up of 14.8 months. Negative biopsy rate of 87.2%, with 100% survival at 1 year.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBlana et al. (2004):\u003c\/strong\u003e 146 patients with stage T1–2 disease, mean follow-up of 22 months. Negative biopsy rate of 93.4%, with 84% survival at 22 months.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFicarra et al. (2006):\u003c\/strong\u003e 30 patients with stage T1–2 disease, median follow-up of 8 months. Negative biopsy rate of 70%, with 90% survival at 1 year.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePoissonnier et al. (2007):\u003c\/strong\u003e 227 patients with stage T1–2 disease, mean follow-up of 27 months. Negative biopsy rate of 86%, with 77% survival at 5 years.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBlana et al. (2008):\u003c\/strong\u003e 140 patients with stage T1–2 disease, mean follow-up of 5 years. Negative biopsy rate of 92%, with 75% survival at 5 years.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBlana et al. (2008):\u003c\/strong\u003e 163 patients with stage T1–2 disease, median follow-up of 6.5 years. Negative biopsy rate of 92%, with 75% survival at 5 years.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch3\u003eTen-Year Long-Term Follow-Up Studies\u003c\/h3\u003e\n\n\u003cp\u003eLong-term data from three major studies confirm the durability of HIFU treatment:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eGanzer et al. (2013):\u003c\/strong\u003e Among 229 low-risk patients, 10-year cancer-specific survival was 100% and 10-year metastases-free survival was 100%. Among 211 intermediate-risk patients, cancer-specific survival was 96% and metastases-free survival was 94%.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eThueroff et al. (2013):\u003c\/strong\u003e Among 704 patients with localized disease (72% moderate or high risk), 10-year cancer-specific survival was 99% and metastases-free survival was 95%.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCrouzet et al. (2014):\u003c\/strong\u003e Among 357 low-risk patients, cancer-specific survival was 99% and metastases-free survival was 99%. Among 452 intermediate-risk patients, cancer-specific survival was 98% and metastases-free survival was 95%. Among 174 high-risk patients, cancer-specific survival was 92% and metastases-free survival was 86%.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch3\u003eIncidental Disease\u003c\/h3\u003e\n\n\u003cp\u003eHistologic examination reveals prostate cancer in up to 8% of patients who undergo adenomectomy, holmium-laser enucleation, or TURP because of symptomatic benign prostatic hyperplasia. Results have been reported in 65 patients treated with HIFU for incidental prostate cancer. The PSA nadir (lowest PSA level after treatment) of 0.07 ng\/mL and the PSA velocity (rate of PSA change) of 0.01 ng\/mL\/year indicated that HIFU can be used as a curative therapy in patients with incidental prostate cancer.\u003c\/p\u003e\n\n\u003ch2 id=\"morbidity\"\u003eHIFU-Related Side Effects and Morbidity\u003c\/h2\u003e\n\n\u003cp\u003eThe most common side effects of primary HIFU therapy include prolonged voiding dysfunction (difficulty urinating) and urinary retention (inability to empty the bladder) caused by edema (swelling), necrosis (tissue death), or bladder outlet obstruction, as well as erectile dysfunction.\u003c\/p\u003e\n\n\u003cp\u003eData from major studies on morbidity following HIFU treatment show the following ranges:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIncontinence (urine leakage):\u003c\/strong\u003e Ranging from 4.6% to 16% depending on the study and whether TURP was performed. Grade I incontinence (loss of urine under heavy exercise requiring 0–1 pad\/day) was most common. For example, Chaussy and Thuroff (2003) reported grade I incontinence in 9.1% and grade II in 4.6% of patients without TURP, but only 4.6% grade I and 2.3% grade II with TURP.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eErectile dysfunction:\u003c\/strong\u003e Ranging from 13% to 61% across studies. The wide range reflects differences in patient age, baseline sexual function, and definition of erectile dysfunction.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFistula (abnormal connection between organs):\u003c\/strong\u003e Rare, ranging from 0% to 1.7%.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eStricture and stenosis (narrowing of the urethra):\u003c\/strong\u003e Ranging from 0% to 27.1%.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePostoperative retention:\u003c\/strong\u003e Ranging from 3.6% to 17%.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eUrinary tract infection:\u003c\/strong\u003e Ranging from 2% to 13.8%.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePostoperative catheter duration:\u003c\/strong\u003e Ranging from 5 to 45.1 days depending on whether a suprapubic or Foley catheter was used.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eNotably, the addition of TURP significantly reduced side effects. In the Chaussy and Thuroff (2003) study, patients without TURP had a 27.1% rate of stricture\/stenosis and 47.9% rate of urinary tract infection, while those with TURP had only 8% stricture\/stenosis and 11.4% urinary tract infection.\u003c\/p\u003e\n\n\u003ch2 id=\"advanced\"\u003eHIFU in Advanced and Hormone-Resistant Disease\u003c\/h2\u003e\n\n\u003cp\u003eIn contrast to most published trials of HIFU therapy that report outcomes in patients with stage T1–T2 disease or radiation failure, the results of a trial that enrolled 113 patients with stage T3–T4 disease followed for a median of 4.6 years were recently presented. The median PSA velocity of this cohort was 0.19 ng\/mL\/year and the cancer-specific survival was 96.4%.\u003c\/p\u003e\n\n\u003cp\u003eAnother study reported the outcomes of 55 men with PSA progression and local biopsy-proven tumor recurrence during definitive hormonal ablation therapy who received HIFU for hormonal-resistant prostate cancer. With a mean follow-up of 21 months, the prostate cancer-specific survival was 87.3%.\u003c\/p\u003e\n\n\u003cp\u003ePreliminary results of palliative treatment with HIFU in patients with advanced prostate cancer showed promising findings based on reductions in local morbidity such as:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eRectal compression\u003c\/li\u003e\n  \u003cli\u003eInfravesical obstruction (blockage below the bladder)\u003c\/li\u003e\n  \u003cli\u003eHydronephrosis (kidney swelling due to urine backup)\u003c\/li\u003e\n  \u003cli\u003eHematuria (blood in the urine)\u003c\/li\u003e\n  \u003cli\u003ePelvic pain syndromes\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eUnpublished data from several large patient groups (n \u0026gt; 70) with stage T3 and castration-resistant prostate cancer with follow-up of 10 years have shown a post-HIFU PSA velocity of 0.19 ng\/mL\/year in T3 disease without additional hormone ablation. Local tumor ablation with HIFU has also resulted in a PSA reduction of 80% in castration-resistant prostate cancer cases. There was also evidence of a synergistic effect with hormone ablative therapies that was reflected in the delay of onset of hormone resistance.\u003c\/p\u003e\n\n\u003ch2 id=\"salvage\"\u003eHIFU as Salvage Therapy\u003c\/h2\u003e\n\n\u003ch3\u003eRationale\u003c\/h3\u003e\n\n\u003cp\u003eHIFU can be used as salvage therapy for locally recurrent disease following almost every curative prostate cancer modality, including external radiation, low-dose rate and high-dose rate brachytherapy, cryoablation, primary HIFU, biochemically progressing PSA, and after combined pretreatment including radical prostatectomy.\u003c\/p\u003e\n\n\u003cp\u003eOne of the factors accounting for the attractiveness of salvage HIFU is related to the extremely limited treatment options for men with recurrent disease following curative therapy. According to CaPSURE data, 63% of the patients treated with external beam radiotherapy experience disease recurrence. For these patients, androgen deprivation therapy (hormone therapy) was used as salvage therapy in 93.5%, and definitive local therapy in only 3.9% (salvage radical prostatectomy 0.9% and cryoablation 3.0%).\u003c\/p\u003e\n\n\u003cp\u003eThe appeal of salvage radical prostatectomy and cryoablation following local radiation failure is more theoretical in nature; in practice, their use represents a complex procedure associated with extremely high morbidity rates and procedural costs.\u003c\/p\u003e\n\n\u003ch3\u003eSalvage of Radiotherapy Failure\u003c\/h3\u003e\n\n\u003cp\u003eSalvage HIFU represents a viable treatment option for men experiencing recurrence after radiation therapy. Although the tissue alteration from radiation therapy results in a higher postoperative morbidity rate than is seen in primary HIFU therapy alone, this does not alter the favorable risk\/benefit ratio with the use of salvage HIFU treatment relative to the other available options.\u003c\/p\u003e\n\n\u003cp\u003eExtremely limited experience exists with salvage HIFU following brachytherapy, but it appears that this approach is not associated with a significant increase in complications compared with primary HIFU.\u003c\/p\u003e\n\n\u003ch3\u003eSalvage of Radical Prostatectomy Failure\u003c\/h3\u003e\n\n\u003cp\u003eTherapeutic options for local recurrence following radical prostatectomy are limited. HIFU offers a treatment option when local recurrence can be identified through transrectal ultrasound (TRUS) and verified with biopsy.\u003c\/p\u003e\n\n\u003cp\u003eAfter a small number of patients with post-prostatectomy failure were treated with HIFU, the treated areas showed negative biopsies in 77% of cases. During follow-up of 5 years, 91% of the patients showed no biochemical progression. Nevertheless, salvage HIFU after radical prostatectomy depends on a TRUS-visible biopsy-proven target and cannot be used as \"post-RPE radiation therapy\" in case of R1 resection (positive surgical margins).\u003c\/p\u003e\n\n\u003ch3\u003eSalvage Radical Prostatectomy Following HIFU Failure\u003c\/h3\u003e\n\n\u003cp\u003eRadical prostatectomy was performed in seven patients experiencing failure following treatment with HIFU between 1996 and 2000 at the authors' institution. Prior treatment with HIFU created severe fibrotic adhesions (scar tissue) between the rectum and Denonvilliers fascia, and although this made salvage radical prostatectomy more technically demanding, it did not result in higher morbidity compared with a standard prostatectomy.\u003c\/p\u003e\n\n\u003ch2 id=\"focal\"\u003eFocal and Partial HIFU Therapy\u003c\/h2\u003e\n\n\u003cp\u003eOver the past 25 years, the average life expectancy of men has increased almost 4 years, while the average age of prostate cancer diagnosis has decreased 10 years. Prostate cancer is also detected at a much earlier stage than two decades ago, with the majority of patients being candidates for curative whole-prostate therapy.\u003c\/p\u003e\n\n\u003cp\u003eA sizable number of patients with small-volume monofocal tumor (cancer confined to a single area) are being overtreated with whole-gland approaches that surgically remove or irradiate the entire prostate. A great need exists for a focal approach to the treatment of small-volume single-lobe prostatic tumor.\u003c\/p\u003e\n\n\u003cp\u003eThe goal of focal HIFU therapy is to provide a partial treatment that is limited to the tumor and a safety margin in patients with noninvasive, monofocal, localized prostate cancer. Such an approach would preserve normal genitourinary function while treating the malignancy with sufficient efficacy.\u003c\/p\u003e\n\n\u003cp\u003eDifferent focal treatment approaches with HIFU are currently being evaluated:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eHemiablation without TURP:\u003c\/strong\u003e A precise focal therapy that treats a maximum 25% of prostate volume without TURP.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePotency-preserving partial therapy:\u003c\/strong\u003e A treatment that excludes the contralateral lobe\/capsule and neurovascular bundle by sparing 5 mm of tissue on the contralateral lobe and treating up to 90% of the prostate.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003ch2 id=\"immune\"\u003eImmunologic Response with HIFU Therapy\u003c\/h2\u003e\n\n\u003cp\u003eSeveral recent studies have examined the potential of HIFU to initiate an immune response. Wu and colleagues studied the effect of HIFU on systemic antitumor immunity, particularly T lymphocyte-mediated immunity in cancer patients.\u003c\/p\u003e\n\n\u003cp\u003eIt has been suggested that endogenous signals from HIFU-damaged tumor cells may trigger the activation of dendritic cells (immune cells that present antigens to T cells), playing a critical role in a HIFU-elicited antitumor immune response. Results showed that HIFU elicited a systemic antitumor immune response that was related closely to dendritic cell activation, and that dendritic cell activation was more pronounced when tumor cells were mechanically lysed (broken apart) by HIFU.\u003c\/p\u003e\n\n\u003cp\u003eThis finding suggests that HIFU may not only destroy the primary tumor but also potentially stimulate the body's immune system to fight cancer cells elsewhere in the body—an exciting area of ongoing research.\u003c\/p\u003e\n\n\u003ch2 id=\"future\"\u003eFuture Directions of HIFU for Prostate Cancer\u003c\/h2\u003e\n\n\u003cp\u003eThe efficacy in cancer control of HIFU and other focal therapies will depend less on the development of therapeutic tools than on diagnostic technologies that can more accurately image and localize tumor lesions and foci. When this goal is reached, HIFU will be the ideal therapeutic tool for focal prostate cancer treatment.\u003c\/p\u003e\n\n\u003cp\u003eThe efficacy in cancer control of HIFU and other focal therapies will depend on precise diagnostic technologies as well as on accurate, safe, and easy-to-apply technologies to localize and ablate tumor foci.\u003c\/p\u003e\n\n\u003cp\u003eToday, already available serial HIFU devices show significant technologic and applicable differences in handling and efficacy. Here is a comparison of the three main devices:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSonablate 450\/500 (by SonaCare):\u003c\/strong\u003e Visual\/manual rectal wall safety control, manual applicator adjustment, maximum ventral prostatic HIFU penetration of 30 mm, manual HIFU power settings, low rectal balloon pressure, TRUS frequency of 4\/6.3 MHz, HIFU frequency of 4 MHz, on\/off rhythmic shot\/delay mode, treatment speed of 90 minutes per 10 cc. TURP recommended for obstructive glands or those \u0026gt;40 cc.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAblatherm Integrated Imaging (by EDAP-TMS):\u003c\/strong\u003e Visual\/manual and automatic US rectal wall safety control, robotic (autofocus) applicator adjustment, maximum ventral prostatic HIFU penetration of 24 mm, automatic HIFU power settings, high rectal balloon pressure, TRUS frequency of 7.5 MHz, HIFU frequency of 3.5 MHz, on\/off rhythmic shot\/delay mode, treatment speed of 60 minutes per 10 cc. TURP recommended for obstructive glands or those \u0026gt;25 cc.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFocal One (by EDAP-TMS):\u003c\/strong\u003e Automatic US rectal wall safety control, robotic (autofocus) applicator adjustment, maximum ventral prostatic HIFU penetration of 40 mm, automatic HIFU power settings, flexible rectal balloon pressure, TRUS frequency of 7.5 MHz, HIFU frequency of 3.5 MHz, on\/continuous shot\/delay mode, treatment speed of 40 minutes per 10 cc. TURP recommended for obstructive glands or those \u0026gt;50 cc.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eBesides picture fusion (combining MRI and ultrasound images), several advancements are being investigated, including multiparametric MRI, high-resolution TRUS, contrast-enhanced ultrasound, elastography (measuring tissue stiffness), and Doppler ultrasound for precise lesion targeting.\u003c\/p\u003e\n\n\u003ch2 id=\"conclusion\"\u003eConclusion\u003c\/h2\u003e\n\n\u003cp\u003eProstate cancer is now diagnosed at an earlier disease stage in younger patients with a longer life expectancy than it was 20 years ago before widespread PSA screening. As a result, the window for curative therapy has been extended, and with patients living longer after definitive therapy, a greater emphasis is now placed on treatment-related morbidity and its impact on the patient's quality of life.\u003c\/p\u003e\n\n\u003cp\u003eLocal recurrence occurs in 10% to 50% of patients regardless of curative approach, and the treatment of prostate cancer has evolved from a singular treatment to a multimodal, sequential approach that greatly accommodates the use of minimally invasive therapies such as HIFU.\u003c\/p\u003e\n\n\u003cp\u003eIn addition, HIFU can be repeated in cases of local recurrence, which is not an option with other treatment modalities for localized prostate cancer such as external radiation, cryosurgery, and brachytherapy.\u003c\/p\u003e\n\n\u003cp\u003eThe use of HIFU should not be viewed as a substitute or replacement for classical therapy, but instead as a therapeutic first choice in monofocal well-differentiated disease. The initial use of HIFU can help postpone the need for invasive therapies associated with greater morbidity such as surgery or radiation, allowing the patient a longer period without the risk of living with treatment-related genitourinary side effects.\u003c\/p\u003e\n\n\u003cp\u003eTransrectal HIFU should be given serious consideration as a curative therapy in localized disease as well as a palliative adjuvant therapy in all other tumor stages. Ongoing improvements in imaging technologies are expected to further enhance the efficacy of HIFU.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is HIFU and how does it work for prostate cancer?\u003c\/h3\u003e\n\u003cp\u003eHIFU is a noninvasive technology that uses focused ultrasound waves to heat and destroy prostate cancer cells. It works by delivering high-energy ultrasound to a precise spot, raising the temperature to 70-100°C in seconds, causing cell death. It does not involve radiation or surgical incisions.\u003c\/p\u003e\n\u003ch3\u003eWho is a candidate for HIFU treatment?\u003c\/h3\u003e\n\u003cp\u003eHIFU is most commonly used for localized prostate cancer (stage T1-2, Gleason ≤6) in men who cannot have surgery due to age or health, or who prefer a non-surgical option. It is also used for partial therapy in low-volume tumors, salvage therapy after recurrence, and for advanced or hormone-resistant cancer.\u003c\/p\u003e\n\u003ch3\u003eHow is HIFU combined with TURP?\u003c\/h3\u003e\n\u003cp\u003eTURP (transurethral resection of the prostate) is often performed before HIFU to remove part of the prostate, reducing its size and clearing calcifications. This improves HIFU's effectiveness and reduces side effects like obstruction and infection. It also allows treatment of larger glands.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal Article Title:\u003c\/strong\u003e high-intensity-focused-ultrasound-for-the-treatment-of-prostate-cancer-a-review\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e \u003ca href=\"https:\/\/doi.org\/10.1089\/end.2016.0548\" target=\"_blank\" rel=\"noopener\"\u003e10.1089\/end.2016.0548\u003c\/a\u003e\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Christian G. Chaussy, MD, HonFRCSEd, and Stefan Thüroff, MD\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e Journal of Endourology, Volume 31, Supplement 1, April 2017, Pages S-30 to S-37\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublisher:\u003c\/strong\u003e Mary Ann Liebert, Inc.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e 10.1089\/end.2016.0548\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor Affiliations:\u003c\/strong\u003e Department of Urology, University Regensburg, Regensburg, Germany; Harlaching Tumor Center, Klinikum Harlaching, Munich, Germany; Department of Urology, Klinikum Harlaching, Munich, Germany\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor Disclosure:\u003c\/strong\u003e No competing financial interests exist.\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eNote: This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and should not replace professional medical advice. Patients considering HIFU or any prostate cancer treatment should consult with their urologist or oncologist to discuss their individual situation.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47377201037468,"sku":null,"price":0.0,"currency_code":"EUR","in_stock":true}],"url":"https:\/\/diagnosticdetectives.ae\/products\/high-intensity-focused-ultrasound-hifu-for-prostate-cancer-a-comprehensive-patients-guide","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}