Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 1/2021

01-01-2021 | Prostate Cancer | NEW IMAGING TECHNIQUES (S Rais-Bahrami and K Porter, Section Editors)

MR-Guided High-Intensity Directional Ultrasound Ablation of Prostate Cancer

Authors: Samuel J. Galgano, Virginia B. Planz, Sandeep Arora, Soroush Rais-Bahrami

Published in: Current Urology Reports | Issue 1/2021

Login to get access

Abstract

Purpose of Review

The goal of this paper was to review the novel treatment modality of high-intensity transurethral directional ultrasound for prostate cancer.

Recent Findings

Prostate cancer is a heterogeneous disease with some patients electing for active surveillance and focal therapies instead of definitive treatment with radical prostatectomy or radiation therapy. Prostate MRI has become a cornerstone of prostate cancer diagnosis, targeted biopsy, and treatment planning. Transurethral high-intensity directional ultrasound allows for MRI-guided ablation of the prostate gland with the ability to contour boundaries and spare critical structures, such as the neurovascular bundle and urinary sphincter. Although results are still emerging, this may offer patients a new option for focal therapy with a favorable side-effect profile.

Summary

High-intensity transurethral directional ultrasound is an emerging treatment modality for both whole-gland and focal ablation with promising early results. Further research is needed to establish safety, tolerability, and long-term oncologic outcomes.
Literature
1.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30.PubMed
2.
3.
Glaser ZA, Gordetsky JB, Bae S, Nix JW, Porter KK, Rais-Bahrami S. Evaluation of MSKCC Preprostatectomy nomogram in men who undergo MRI-targeted prostate biopsy prior to radical prostatectomy. Urol Oncol. 2019;37(12):970–5.CrossRefPubMedPubMedCentral
4.
Kattan MW, Eastham JA, Stapleton AM, Wheeler TM, Scardino PT. A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst. 1998;90(10):766–71.CrossRefPubMed
5.
Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA, et al. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016;40(2):244–52.PubMed
6.
Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 2015;313(4):390–7.CrossRefPubMedPubMedCentral
7.
Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018;378(19):1767–77.CrossRefPubMedPubMedCentral
8.
Gordetsky JB, Saylor B, Bae S, Nix JW, Rais-Bahrami S. Prostate cancer management choices in patients undergoing multiparametric magnetic resonance imaging/ultrasound fusion biopsy compared to systematic biopsy. Urol Oncol. 2018;36(5):241 e7–e13.CrossRef
9.
Carroll PR, Presti JC Jr, Small E, Roach M 3rd. Focal therapy for prostate cancer 1996: maximizing outcome. Urology. 1997;49(3A Suppl):84–94.CrossRefPubMed
10.
Gelet A, Chapelon JY, Margonari J, Theillere Y, Gorry F, Souchon R, et al. High-intensity focused ultrasound experimentation on human benign prostatic hypertrophy. Eur Urol. 1993;23(Suppl 1):44–7.CrossRefPubMed
11.
Madersbacher S, Pedevilla M, Vingers L, Susani M, Marberger M. Effect of high-intensity focused ultrasound on human prostate cancer in vivo. Cancer Res. 1995;55(15):3346–51.PubMed
12.
Beerlage HP, van Leenders GJ, Oosterhof GO, Witjes JA, Ruijter ET, van de Kaa CA, et al. High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study. Prostate. 1999;39(1):41–6.CrossRefPubMed
13.
14.
Johnston MJ, Emara A, Noureldin M, Bott S, Hindley RG. Focal high-intensity focussed ultrasound partial gland ablation for the treatment of localised prostate cancer: a report of medium-term outcomes from a single-center in the United Kingdom. Urology. 2019;133:175–81.CrossRefPubMed
15.
Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D’Amico AV, Dmochowski RR, et al. Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol. 2007;177(2):540–5.CrossRefPubMed
16.
Roach M 3rd, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006;65(4):965–74.CrossRefPubMed
17.
Huber PM, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, et al. Prostate specific antigen criteria to diagnose failure of cancer control following focal therapy of nonmetastatic prostate cancer using high intensity focused ultrasound. J Urol. 2020;203(4):734–42.CrossRefPubMed
18.
Rosenhammer B, Niessen C, Rotzinger L, Reiss J, Schnabel MJ, Burger M, et al. Oncological outcome and value of postoperative magnetic resonance imaging after focal high-intensity focused ultrasound therapy for prostate cancer. Urol Int. 2019;103(3):270–8.CrossRefPubMed
19.
Chopra R, Colquhoun A, Burtnyk M, N’Djin WA, Kobelevskiy I, Boyes A, et al. MR imaging-controlled transurethral ultrasound therapy for conformal treatment of prostate tissue: initial feasibility in humans. Radiology. 2012;265(1):303–13.CrossRefPubMed
20••.
Chin JL, Billia M, Relle J, Roethke MC, Popeneciu IV, Kuru TH, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective phase 1 clinical trial. Eur Urol. 2016;70(3):447–55 Of major importance: Initial phase 1 trial of MRI-guided transurethral ablation of the prostate for prostate cancer.
21.
Ramsay E, Mougenot C, Staruch R, Boyes A, Kazem M, Bronskill M, et al. Evaluation of focal ablation of magnetic resonance imaging defined prostate cancer using magnetic resonance imaging controlled transurethral ultrasound therapy with prostatectomy as the reference standard. J Urol. 2017;197(1):255–61.CrossRefPubMed
22.
Bonekamp D, Wolf MB, Roethke MC, Pahernik S, Hadaschik BA, Hatiboglu G, et al. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. Eur Radiol. 2019;29(1):299–308.CrossRefPubMed
23.
24.
Preisser F, Cooperberg MR, Crook J, Feng F, Graefen M, Karakiewicz PI, et al. Intermediate-risk prostate cancer: stratification and management. Eur Urol Oncol. 2020;3:270–80.CrossRefPubMed
25.
Scheltema MJ, Tay KJ, Postema AW, de Bruin DM, Feller J, Futterer JJ, et al. Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project. World J Urol. 2017;35(5):695–701.CrossRefPubMed
26.
Thomsen FB, Roder MA, Jakobsen H, Langkilde NC, Borre M, Jakobsen EB, et al. Active surveillance versus radical prostatectomy in favorable-risk localized prostate cancer. Clin Genitourin Cancer. 2019;17(4):e814–e21.CrossRefPubMed
27.
Ingrosso G, Becherini C, Lancia A, Caini S, Ost P, Francolini G, et al. Nonsurgical salvage local therapies for radiorecurrent prostate cancer: a systematic review and meta-analysis. Eur Urol Oncol. 2020;3(2):183–97.CrossRefPubMed
28.
Marconi L, Stonier T, Tourinho-Barbosa R, Moore C, Ahmed HU, Cathelineau X, et al. Robot-assisted radical prostatectomy after focal therapy: oncological, functional outcomes and predictors of recurrence. Eur Urol. 2019;76(1):27–30.CrossRefPubMed
29.
Nair SM, Stern N, Dewar M, Siddiqui K, Smith E, Gomez JA, et al. Salvage open radical prostatectomy for recurrent prostate cancer following MRI-guided transurethral ultrasound ablation (TULSA) of the prostate: feasibility and efficacy. Scand J Urol. 2020;54(3):215–9. https://​doi.​org/​10.​1080/​21681805.​2020.​1752795.
30.
Mohler JL, Antonarakis ES, Armstrong AJ, D’Amico AV, Davis BJ, Dorff T, et al. Prostate cancer, version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2019;17(5):479–505.CrossRef
31.
Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol. 2018;199(3):683–90.CrossRefPubMed
32.
Sonni I, Eiber M, Fendler WP, Alano RM, Vangala SS, Kishan AU, et al. Impact of (68)Ga-PSMA-11 PET/CT on staging and management of prostate cancer patients in various clinical settings: a prospective single center study. J Nucl Med. 2020;61:1153–60.CrossRefPubMedPubMedCentral
33.
Sundaram KM, Staruch R, Burtnyk M, Lane JS, Penson DF, Arora SS. Magnetic resonance imaging-guided transurethral ultrasound ablation of localized prostate cancer: preliminary experience from a single center in a prospective, multi-center, single-arm clinical trial. J Vasc Interv Radiol. 2020;31(5):740–6. https://​doi.​org/​10.​1016/​j.​jvir.​2019.​12.​802.
34.
Hatiboglu G, Popeneciu V, Bonekamp D, Burtnyk M, Staruch R, Pahernik S, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: single-center evaluation of 6-month treatment safety and functional outcomes of intensified treatment parameters. World J Urol. 2020;38(2):343–50.CrossRefPubMed
35••.
Sundaram KM, Staruch R, Burtnyk M, Lane JS, Penson DF, Arora SS. MR imaging-guided transurethral ultrasound ablation of localized prostate cancer: preliminary experience from a single center in a prospective, multi-center, single-arm clinical trial. J Vasc Interv Radiol. 2020;31(5):740–6 e4 Of major importance: Initial published data from the phase 2 trial of TULSA for MRI-guided transurethral ultrasound ablation of prostate cancer.CrossRefPubMed
Metadata
Title
MR-Guided High-Intensity Directional Ultrasound Ablation of Prostate Cancer
Authors
Samuel J. Galgano
Virginia B. Planz
Sandeep Arora
Soroush Rais-Bahrami
Publication date
01-01-2021
Publisher
Springer US
Published in
Current Urology Reports / Issue 1/2021
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-020-01020-y

Other articles of this Issue 1/2021

Current Urology Reports 1/2021 Go to the issue

NEW IMAGING TECHNIQUES (S Rais-Bahrami and K Porter, Section Editors)

Dual-Energy CT for Urinary Stone Evaluation

Benign Prostatic Hyperplasia (K McVary, Section Editor)

What Is New with Rezūm Water Vapor Thermal Therapy for LUTS/BPH?

NEW IMAGING TECHNIQUES (S Rais-Bahrami and K Porter, Section Editors)

From Diagnosis to Therapy—PET Imaging for Pheochromocytomas and Paragangliomas

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Efficacy and Safety of Mirabegron in Men with Overactive Bladder Symptoms and Benign Prostatic Hyperplasia