Stefan Thüroff

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

PURPOSE To establish a consensus in relation to case selection, conduct of therapy, and outcomes that are associated with focal therapy for men with localized prostate cancer. MATERIAL AND METHODS Urologic surgeons, radiation oncologists, radiologists, and histopathologists from North America and Europe participated in a consensus workshop on focal therapy for prostate cancer. The consensus process was face to face within a structured meeting, in which pertinent clinical issues were raised, discussed, and agreement sought. Where no agreement was possible, this was acknowledged, and the nature of the disagreement noted. RESULTS Candidates for focal treatment should have unilateral low- to intermediate-risk disease with clinical stage <or=cT(2a). Prostate size and both tumor volume and tumor topography are important case selection criteria that depend on the ablative technology used. Currently, the best method to ascertain the key characteristics for men who are considering focal therapy is exposure to transperineal template mapping biopsies. MRI of the prostate using novel techniques such as dynamic contrast enhancement and diffusion weighed imaging are increasingly being used to diagnose and stage primary prostate cancer with excellent results. For general use, however, these new techniques require validation in prospective clinical trials. Until such are performed, MRI will, in most centers, continue to be an investigative tool in assessing eligibility of patients for focal therapy. CONCLUSIONS Consensus was derived for most of the key aspects of case selection, conduct of treatment, and outcome measures for men who are undergoing focal therapy for localized prostate cancer. The level of agreement achieved will pave the way for future collaborative trials.

High-intensity focused ultrasound for prostate cancer: comparative definitions of biochemical failure.

To compare the specificity and sensitivity of different definitions of biochemical failure in patients treated with high‐intensity focused ultrasound (HIFU) for prostate cancer, to identify the most accurate predictor of clinical failure after HIFU.

Treatment of Renal Stones by Extracorporeal Shockwave Lithotripsy

Aim: Despite the extensive experience with minimal invasive stone therapy, there are still different views on the ideal management of renal stones. Materials and Methods: Analysis of the literature includes more than 14,000 patients. We have compared these data with long–term results of two major stone centers in Germany. The results have been compared concerning the anatomical kidney situation, stone size, stone localization and observation time. Results: According to the importance of residual fragments following extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between clinically insignificant residual fragments and clinically significant residual fragments (CIRF). 24 months following ESWL stone passage occurs as a continous process, and if there are no clinical symptoms, any endoscopic procedure should be considered as overtreatment. According to these results, stone–free rates of patients increase in longer follow–up periods. Newer ESWL technology has increased the percentage of CIRF. Conclusion: We consider ESWL in most patients with renal calculi as first–line treatment, except in patients with renal calculi bigger than 30 mm in diameter.

Technology Insight: high-intensity focused ultrasound for urologic cancers

The growing interest in high-intensity focused ultrasound (HIFU) technology is mainly due to its many potential applications as a minimally invasive therapy. It has been introduced to urologic oncology as a treatment for prostate and kidney cancers. While its application in the kidney is still at the clinical feasibility phase, HIFU technology is currently used in daily practice in Europe for the treatment of prostate cancer. Literature describing the results of HIFU for prostate cancer is mainly based on several series of patients from clinical development teams. The latest published results suggest that HIFU treatment is a valuable option for well-differentiated and moderately-differentiated tumors, as well as for local recurrence after external-beam radiation therapy.

Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma ☆

OBJECTIVES High-intensity focused ultrasound (HIFU) consists of focused ultrasound waves emitted from a transducer that are capable of inducing tissue damage. The histologic effects and clinical outcome of the HIFU treatment were studied in two different groups of men with prostate carcinoma. METHODS The HIFU treatment was performed under regional or general anesthesia with the Ablatherm device. In one group, HIFU was performed 7 to 12 days before radical prostatectomy, and meticulous histopathologic examination of the radical prostatectomy specimens was performed. The second group consisted of patients with localized prostate carcinoma for whom radical prostatectomy was not an option and who received HIFU treatment alone. RESULTS In 14 patients treated with HIFU before radical prostatectomy, complete necrosis was seen in the treated region in all cases. On the dorsal border, however, incomplete destruction of tissue was noted, and in 4 cases a small vital tumor focus was seen. In the second group, of those patients in whom the entire prostate was treated, a negative biopsy result and a prostate-specific antigen (PSA) level less than 4 ng/mL was obtained in 60% and a PSA nadir less than 0.5 ng/mL in 55% of patients. CONCLUSIONS HIFU treatment results in the two groups clearly demonstrate the potential of this modality in the treatment of localized prostate carcinoma. This study showed that extensive coagulative necrosis can be obtained in the treated areas; however, exact targeting is crucial and a prerequisite for extended clinical application of HIFU.

High-intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer

Whats known on the subject? and What does the study add?

Transrectal high-intensity focused ultrasound devices: a critical appraisal of the available evidence.

Developments in the technology applied to the field of minimally invasive surgery have led to the exploration of high-intensity focused ultrasound (HIFU) for the treatment of localized prostate cancer. Extensive research and continuous evolution have resulted in two commercially available HIFU devices: the Ablatherm and the Sonablate500. These devices are conceptually the same; however, specific technical differences exist. This paper reviews the clinical outcomes obtained with these devices, evaluates the quality of the evidence from the individual trials, and provides the results of a head-to-head comparison in terms of oncologic outcomes and complication rates.

Correlation of prostate-specific antigen nadir and biochemical failure after high-intensity focused ultrasound of localized prostate cancer based on the Stuttgart failure criteria - Analysis from the @-Registry

Study Type – Prognosis (retrospective cohort)

High-intensity focused ultrasound in the management of prostate cancer

The treatment of localized prostate cancer with high-intensity focused ultrasound (HIFU) has been researched since the 1990s and today the treatment is an actively used therapy for the disease. HIFU works in two ways to destroy tissue, namely thermal and mechanical effects. The most recent data on the Ablatherm® HIFU device come from an international registry (@-Registry) and indicate a 5-year biochemical survival rate of 85%. HIFU is commonly used in conjunction with transurethral resection of the prostate in order to reduce prostate gland size and facilitate effective tissue destruction. An additional benefit of HIFU is that it can be used as salvage therapy after radical prostatectomy and external-beam radiotherapy. A new area of research with HIFU involves focal therapy, where tumor sites within the gland are directly targeted with the objective of reducing morbidity.

The Use of High-Intensity Focused Ultrasound in Prostate Cancer

The use of ultrasonic waves for medical purposes was first investigated in the 1950s, 1 and high-intensity focused ultrasound (HIFU) for focal tissue destruction was established in 1955. 2 One of the first clinical applications of HIFU was for the treatment of neurological disorders by the production of small lesions deep inside the cerebral cortex. Routine use of the technique, however, was limited by the need for a large cranial bone flap and by the lack of an appropriate imaging device. Exploration of the use of HIFU for the irradiation of tumors started in 1956, 3 continued during the late 1970s and early 1980s, 4, 5 and by the mid-1980s, the technique was being used to treat ocular cancers and glaucoma. 6 The use of HIFU in the treatment of prostate disorders began in the early 1990s with clinical trials of HIFU in the treatment of benign prostatic hyperplasia (BPH) 7, 8 and the treatment of organ-confined prostate cancer. 9