Focused Ultrasound Promising in Localized Prostate Cancer

March 27, 2002

NEW YORK (MedscapeWire) Mar 28 — High-intensity focused ultrasound (HIFU) looks promising in treatment of localized prostate cancer, according to results of a preliminary trial reported in the March issue of Urology.

"HIFU delivers ultrasound energy with rapid thermal necrosis of tissue in the focal region without damaging the surrounding tissue," write Toyoaki Uchida and colleagues from Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. "Transrectal HIFU may be a useful option for patients with localized prostate cancer. Its long-term efficacy will be determined by additional follow-up and a Phase II trial."

All 20 patients with stage T1b-2N0M0 localized prostate cancer had complete response to a course of 28 HIFU treatments, with no evidence of disease and no elevations of prostate-specific antigen after tumor ablation.

One patient developed rectourethral fistula, 2 patients experienced urethral stricture, and 1 patient underwent transurethral resection of the prostate because of prolonged urinary retention.

"Our results show that HIFU can be performed without an incision, with a less severe side effect profile, and, unlike most other prostate treatments, is repeatable," the authors write.

In an accompanying editorial, John M. Fitzpatrick, MCh, FRCSI, from University College in Dublin, Ireland, notes several caveats. Ultrasound therapy of benign prostatic hypertrophy has now fallen out of favor because reliable efficacy was never proved.

Before recommending ultrasound therapy for prostate cancer, he suggests that "the exact type of patient who might benefit from it should be defined more strictly, the follow-up should be longer, and the side effects...should be lowered to more acceptable levels."

The authors address his concerns and acknowledge the need for additional experience, but counter, "At present, we are convinced that the HIFU therapy could replace the reference standard of radical prostatectomy for localized prostate cancer in the future."

Urology. 2002;59(3):394-399

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