Tetsuro Tomonaga

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.

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.

Dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy

To describe a novel dorsal vein complex preserving technique for intrafascial nerve‐sparing laparoscopic radical prostatectomy and to evaluate its postoperative outcomes.

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.

Comparison between high-intensity focused ultrasound devices for the treatment of patients with localized prostate cancer

To evaluate the association between long-term clinical outcomes and morbidity of patients with prostate cancer who underwent high-intensity focused ultrasound (HIFU). We included 918 patients with stage T1c-T3N0M0 prostate cancer who were treated with Sonablate™ (SB) devices during 1999–2012 and followed-up for >2 years. Risk stratification and complication rates were compared between the treatment groups. The 10-year overall and cancer-specific survival rates were 89.6% and 97.4%, respectively. The 5-year biochemical disease-free survival (bDFS) rates in the SB200/500, SB500 version 4, and SB500 tissue change monitor groups were 48.3%, 62.3%, and 82.0%, respectively (p < 0.0001). In the low-, intermediate-, and high-risk categories, the 10-year bDFS rates for all patients were 63%, 52%, and 32%, respectively (p < 0.0001), whereas the 5-year bDFS rates in the tissue change monitor group were 95%, 84%, and 72%, respectively (p = 0.0134). The overall negative biopsy rate was 87.3%. Multivariate analysis sho...

Prostate cancer with cyst formation detected by whole body positron emission tomography/computed tomography: A case report

The present study reports a case of prostate adenocarcinoma with cyst formation. A 72-year-old male diagnosed with multiple lung metastases at a local clinic was referred to Tokai University Hachioji Hospital (Tokyo, Japan) for detection of a primary lesion. Whole body positron emission tomography/computed tomography showed strong accumulation of [18F]-fluoro-deoxy-2-glucose (FDG) in the small pelvis, and pelvic magnetic resonance imaging revealed a 60×40-mm cystic lesion, with an irregular thickened wall, behind the prostate. The serum prostate-specific antigen (PSA) level was elevated to 211.99 ng/ml, therefore, the patient underwent a transperineal prostate needle biopsy, and was diagnosed with prostate adenocarcinoma with cyst formation. Androgen deprivation therapy was administered for 8 months following the diagnosis of prostate cancer; consequently, the cyst reduced in size and the serum PSA level decreased to 0.14 ng/ml. To the best of our knowledge, this is the first report of a malignant prostatic cyst detected by FDG-positron emission tomography/computed tomography.

Morphological analysis of the effects of intraoperative transrectal compression of the prostate during high-intensity focused ultrasound for localized prostate cancer

To evaluate the effects of transrectal compression of the prostate for intra‐operative prostatic swelling and intraprostatic point shift during high‐intensity focused ultrasound treatment of localized prostate cancer.

High-intensity focused ultrasound (HIFU) using Sonablate{trade mark, serif} devices for the treatment of localized prostate cancer: 13-year experience

To report on the long-term results of high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Eight hundred and eighty-four men with prostate cancer treated with Sonablate® (SB) devices were included. All patients were followed for more than 2 years. The patients were divided into three groups: in the first group, 419 patients were treated with SB200/500 from 1999 to 2006; in the second group, 263 patients were treated with SB 500 ver. 4 from 2005 to 2009: in the third group, 202 patients were treated with SB 500 TCM from 2007 up to present. Biochemical failure was defined according to the Phoenix definition (PSA nadir + 2 ng/ml). The mean age, PSA, Gleason score, operation time, and follow-up period in each group were 68, 66 and 67 years, 11.2, 9.7 and 9.3 ng/ml, 6.2, 6.6 and 6.7, 167, 101 and 106 min, and 56, 48 and 36 months, respectively. The biochemical disease-free rate (bDFR) in each group at 5 years was, respectively, 54%, 61% and 84%, and was 50% at 10 years in the...