High intensity focused ultrasound (HIFU) has been used since the beginning of the 1990s as an alternative treatment for prostate cancer.
Overview of the current status and critical review of the different indications for HIFU in the treatment of prostate cancer.
Review of the current literature on the indications, side effects, oncologic results and current guideline recommendations.
The principle of HIFU is based on high energy sound waves, which lead to coagulation necrosis at the focal point. It can be applied for different indications: complete ablation of prostatic tissue is attempted in whole gland HIFU in the primary treatment of localized prostate cancer. There are several case series in the current literature with a maximum median follow-up of 8.1 years. The main side effect is the formation of bladder neck sclerosis. A further indication is for salvage HIFU in patients with localized recurrent prostate cancer after radiotherapy. This is a high-risk procedure due to increased risk of incontinence and formation of rectourethral fistula. Focal therapy is an innovative field aiming at partial prostate gland ablation with HIFU thereby reducing side effects. Technical improvements in HIFU enable treatment planning with fusion of multiparametric magnetic resonance imaging (mpMRI). Due to the experimental character, this should only be carried out within clinical trials.
Due to a lack of prospective randomized trials and limited long-term results, whole gland HIFU is considered differently in the guidelines of European countries. Focal therapy is still experimental and should only be carried out within clinical trials.
Der Radiologe. 2017 Apr 24 [Epub ahead of print]
R Ganzer
Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland. .