Mayura Nakano

Transrectal high-intensity focused ultrasound for the treatment of localized prostate cancer: eight-year experience.

Objective:  To report on the long‐term results of high‐intensity focused ultrasound in the treatment of localized prostate cancer.

High‐intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after external beam radiation, brachytherapy or proton therapy

Study Type – Therapy (case series)
Level of Evidence 4

Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study.

Objectives:  To report our health‐related quality of life (QOL) and functional outcomes following high‐intensity focused ultrasound (HIFU) for localized prostate cancer.

Improved Outcomes with Advancements in High Intensity Focused Ultrasound Devices for the Treatment of Localized Prostate Cancer

PURPOSE We evaluated the association between long-term clinical outcomes and morbidity with high intensity focused ultrasound. MATERIALS AND METHODS We included patients with stage T1c-T3N0M0 prostate cancer who were treated with Sonablate® (SB) devices during 1999 to 2012 and followed for more than 2 years. Risk stratification and complication rates were compared among the treatment groups (ie SB200/500 group, SB500 version 4 group and SB500 tissue change monitor group). Primary study outcomes included overall, cancer specific and biochemical disease-free survival rates determined using Kaplan-Meier analysis (Phoenix definition). Secondary outcomes included predictors of biochemical disease-free survival using Cox models. RESULTS A total of 918 patients were included in the study. Median followup in the SB200/500, SB500 version 4 and the SB500 tissue change monitor groups was 108, 83 and 47 months, respectively. The 10-year overall and cancer specific survival rates were 89.6% and 97.4%, respectively. The 5-year biochemical disease-free survival rate in the SB200/500, SB500 version 4 and SB500 tissue change monitor group was 48.3%, 62.3% and 82.0%, respectively (p < 0.0001). The overall negative biopsy rate was 87.3%. On multivariate analysis pretreatment prostate specific antigen, Gleason score, stage, neoadjuvant androgen deprivation therapy and high intensity focused ultrasound devices were significant predictors of biochemical disease-free survival. Urethral stricture, epididymitis, urinary incontinence and rectourethral fistula were observed in 19.7%, 6.2%, 2.3% and 0.1% of cases, respectively. CONCLUSIONS Long-term followup of patients with high intensity focused ultrasound demonstrated improved clinical outcomes due to technical, imaging and technological advancements.

High-intensity focused ultrasound therapy for prostate cancer.

Abstract:  Recent advances in high‐intensity focused ultrasound, which was developed in the 1940s as a viable thermal tissue ablation approach, have increased its popularity. High‐intensity focused ultrasound is currently utilized the most in Europe and Japan, but has not yet been approved by the Food and Drug Administration, USA, for this indication. The purpose of the present report is to review the scientific foundation of high‐intensity focused ultrasound technology and the clinical outcomes achieved with commercially available devices. Recently published articles were reviewed to evaluate the current status of high‐intensity focused ultrasound as a primary or salvage treatment option for localized prostate cancer. Improvements in the clinical outcome as a result of technical, imaging and technological advancements are described herein. A wide range of treatment options for organ‐confined prostate cancer is available. However, high‐intensity focused ultrasound is an attractive choice for men willing to choose less invasive options, although establishing the efficacy of high‐intensity focused ultrasound requires longer follow‐up periods. Technological advances, together with cultural and economic factors, have caused a dramatic shift from traditional open, radical prostatectomy to minimally invasive techniques. High‐intensity focused ultrasound is likely to play a significant role in the future of oncology practice.

Manually controlled targeted prostate biopsy with real‐time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound: An early experience

To report our early experience with manually controlled targeted biopsy with real‐time multiparametric magnetic resonance imaging and transrectal ultrasound fusion images for the diagnosis of prostate cancer.

IgG4-related inflammatory pseudotumor of the kidney

IgG4-related disease is a systemic disease characterized by extensive IgG4-positive plasma cells and T lymphocyte infiltration of various organs, such as sclerotic sialadenitis, hypothyroidism, interstitial pneumonia, cholangitis, autoimmune pancreatitis, retroperitoneal fibrosis, tubulointerstitial nephritis, prostatitis, and inflammatory pseudotumor of lung, mammary gland and kidney. A 56-year-old woman was referred to Tokai University Hachioji Hospital with a renal tumor, which was found incidentally by abdominal ultrasonography during a medical examination. There was no history of previous illness. General blood tests and urinalysis showed normal values. Abdominal ultrasonography showed low echoic mass and computed tomography (CT) showed a renal tumor located at the lower pole of the left kidney in low-attenuation areas, compared with the normal renal cortex during the first phase of enhancement. The tumor was slightly enhanced during the second phase of enhancement (Fig. 1a). On T1-weighted magnetic resonance images (MRI), the tumor was isointense, and on T2-weighted images, the tumor was hypointense (Fig. 1b). We diagnosed the tumor as papillary renal cell carcinoma, and carried out laparoscopic radical nephrectomy. Macroscopically, the resected specimen of the renal tumor showed a 45 ¥ 35 ¥ 35 mm-sized white and jagged verge mass lesion (Fig. 1c). Microscopically, the tumor had no capsule and consisted of diffuse lymphoplasmacytic infiltration with fibrosis. Immunohistochemically, the IgG4 positive plasma cells infiltrated diffusely (mean of 42 cells/HPF per field of 0.62 mm) (Fig. 1d). Therefore, the final diagnosis was IgG4 related inflammatory pseudotumor of the kidney. Serum IgG4 levels were normal (68.9 mg/dL) at 1 month after operation and there was no suspicion of IgG4related disease from head to foot at 12 months after operation without any additional therapy. In an imaging study, 30 cases of IgG4-related kidney disease showed as renal masses or nodules (20 cases, 67%), nothing particular (6 cases, 20%), pelvic wall thickening (3 cases, 10%), kidney swelling (2 cases, 7%) and irregular patchy (1 case, 3%). The diagnostically important features in patients with IgG4-related systemic disease are elevated serum IgG4 levels and/or abundant infiltration of affected organs by IgG4-positive plasma cells. Cornell et al. suggested the criteria for immunohistological diagnosis of infiltrating IgG4-positive plasma cells in organs are more than 30 cells/high-power field per field of 0.62 mm. If the tumor had been diagnosed as an IgG4-related inflammatory pseudotumor of the kidney before operation, we might not have carried out surgery, and instead carried out needle biopsy and provided steroid therapy. So, it is important to consider a differential diagnosis with IgG4-related inflammatory pseudotumor of the kidney similar to imaging in our case and the presence of systemic inflammation disease. Zen et al. reported that T helper (Th) 2 cells and regulatory immune reactions, such as regulatory T cells (Tregs), IL-10 and TGF-b, are upregulated in cases of IgG4-related diseases. We found some Tregs (positive staining of CD4 and 25) with fibrosis in the present case. So, IgG4-related inflammatory pseudotumor of the kidney might be affected by Tregs; but it will be important in the future to study why Th2 cells and Tregs are upregulated in cases of IgG4-related disease.

Salvage high-intensity focused ultrasound for biopsy-confirmed local recurrence of prostate cancer after radical prostatectomy

Study Type – Therapy (case series)
 Level of Evidence 4

Urethra-sparing high-intensity focused ultrasound for localized prostate cancer: Functional and oncological outcomes

To evaluate longitudinal changes in urinary function and quality of life, and the oncological outcomes of patients treated with urethra‐sparing high‐intensity focused ultrasound for localized prostate cancer.

Time-dependent change of blood flow in the prostate treated with high-intensity focused ultrasound.

Avascular areas on contrast‐enhanced magnetic resonance imaging have been considered to be areas of localized prostate cancer successfully treated by high‐intensity focused ultrasound. However, the optimal timing of magnetic resonance imaging has not been discussed. The thermal effect of high‐intensity focused ultrasound is degraded by regional prostatic blood flow. Conversely, the mechanical effect of high‐intensity focused ultrasound (cavitation) is not affected by blood flow, and can induce vessel damage. In this series, the longitudinal change of blood flow on contrast‐enhanced magnetic resonance imaging was observed from postoperative day 1 to postoperative day 14 in 10 patients treated with high‐intensity focused ultrasound. The median rates of increase in the non‐enhanced volume of the whole gland, transition zone and peripheral zone from postoperative day 1 to postoperative day 14 were 36%, 39%, and 34%, respectively. In another pathological analysis of the prostate tissue of 17 patients immediately after high‐intensity focused ultrasound without neoadjuvant hormonal therapy, we observed diffuse coagulative degeneration and partial non‐coagulative prostate tissue around arteries with vascular endothelial cell detachment. These observations on contrast‐enhanced magnetic resonance imaging support a time‐dependent change of the blood flow in the prostate treated with high‐intensity focused ultrasound. Additionally, our pathological findings support the longitudinal changes of these magnetic resonance imaging findings. Further large‐scale studies will investigate the most appropriate timing of contrast‐enhanced magnetic resonance imaging for evaluation of the effectiveness of high‐intensity focused ultrasound for localized prostate cancer.