Treatment of organ localized prostate cancer by High Intensity Focus Ultrasound: 15 years of clinical experience

The incidence of prostate cancer (Pca) has risen since the implementation of prostate specific antigen. The standard treatment for organ localised prostate cancer is radical prostatectomy (RP) and external beam radiation therapy (EBRT). However, RP has not shown to improve cancer specific survival in patients older than 65 years with low and intermediary risk PCa and treatment may induce significant side effects. EBRT may cause urinary and gastrointestinal toxicity and roughly one third of patients experience local recurrence. For these reasons, there is considerable overtreatment, and there is a need of mini invasive treatment options.Treatment by high intensity focused ultrasound (HIFU) Ablatherm® has been developed and improved progressively. During the last 15 years, 33 000 patients have been treated. Studies have showed that HIFU offers comparable cancer control to RP when used as primary treatment for localised prostate cancer in patients older than 70 years. HIFU causes milder surgical complications and may be repeated in case of cancer recurrence.ERBT induces vasculature changes in the prostate and rectal wall tissue. This makes the tissue vulnerable to salvage treatments (RP, HIFU, Cryotherapy) in case of local recurrence. However, by adjusting the HIFU energy parameters for these patients, side effects have been significantly reduced and salvage HFU is better tolerated than salvage prostatectomy.Improvement in prostate imaging techniques and after introduction of image-based prostate biopsies, better patient selection for focal treatment is possible. In this way, the energy is deposited onto a smaller volume, and thereby minimizes side effects and better preserves quality of life. Focal treatment may be performed in an ambulatory care setting.