Les ultrasons focalisés de haute intensité (HIFU) dans le traitement du cancer de la prostate / High intensity focused ultrasound (HIFU) in the treatment of prostate cancer
Seance of wednesday 05 april 2023 (Place des ultrasons focalisés à haute intensité en thérapeutique)
DOI number : 10.26299/fxx3-5r97/emem.2023.13.07
Abstract
Therapeutic ultrasound, well known in urology since extracorporeal lithotripsy, has been the subject of experimental studies for the treatment of prostate cancer since the 1990s.
Targeted tissues are electively heated to more than 80° by real-time image-guided surgical navigation, which leads to their immediate destruction coupled with coagulation of the afferent micro-vessels and followed by the progressive appearance of a scar-like fibrosis devoid of glandular elements. The first clinical applications began with the century. They followed the process common to disruptive innovations, which was all the more lengthy as it involved demonstrating an improvement in a medical service rendered in curative oncology, thus requiring sufficient follow-up. The improvement consists of a conservative treatment, without excision or irradiation, significantly reducing the risks of urinary incontinence and erectile dysfonction, without any oncological risk. The first large retrospective studies were published in 2014 and a derogatory reimbursement was then obtained in France, conditional on the completion of a controlled multicenter non-inferiority study comparing HIFU to the reference surgical treatment (radical prostatectomy) for localized cancer of ISUP groups 1 and 2, not eligible for active surveillance. The pre-final results will be presented.
They should lead to a modification of the treatment strategy by limiting the indication of radical treatments to the most severe cases, and confirm, for well selected cases, the orientation towards a partial treatment of the prostate.
Targeted tissues are electively heated to more than 80° by real-time image-guided surgical navigation, which leads to their immediate destruction coupled with coagulation of the afferent micro-vessels and followed by the progressive appearance of a scar-like fibrosis devoid of glandular elements. The first clinical applications began with the century. They followed the process common to disruptive innovations, which was all the more lengthy as it involved demonstrating an improvement in a medical service rendered in curative oncology, thus requiring sufficient follow-up. The improvement consists of a conservative treatment, without excision or irradiation, significantly reducing the risks of urinary incontinence and erectile dysfonction, without any oncological risk. The first large retrospective studies were published in 2014 and a derogatory reimbursement was then obtained in France, conditional on the completion of a controlled multicenter non-inferiority study comparing HIFU to the reference surgical treatment (radical prostatectomy) for localized cancer of ISUP groups 1 and 2, not eligible for active surveillance. The pre-final results will be presented.
They should lead to a modification of the treatment strategy by limiting the indication of radical treatments to the most severe cases, and confirm, for well selected cases, the orientation towards a partial treatment of the prostate.