Purpose of Technology: High-intensity focused ultrasound (HIFU) is a minimally invasive (transrectal) treatment that generates heat through sound energy to destroy tumor tissue. Sound waves produced by an ultrasonic transducer mounted on an endorectal probe penetrate the rectal wall and ablate the entire prostate gland or focal areas containing tumor while avoiding damage to normal tissue. This outpatient procedure has been evaluated for patients with prostate cancer who prefer a less invasive option than prostatectomy or who are not appropriate surgical candidates.

Rationale: The goals of the minimally invasive therapy ultrasound-guided HIFU for localized prostate cancer are to use focused ultrasound waves to thermally ablate the cancerous prostate gland and achieve complete tumor control while avoiding the morbidity associated with more invasive therapies (e.g., prostatectomy) such as adverse effects on urinary and sexual function.

Controversy: Although minimally invasive locally ablative therapies such as HIFU may have lower morbidity compared with radical prostatectomy and radiotherapy for prostate cancer, questions remain about the long-term efficacy of procedures for tumor control, particularly if they are used to treat focal areas of the gland since untreated tumor tissue may lie outside the treatment zone. HIFU may also lead to overtreatment of indolent prostate cancers in patients for whom active surveillance would lead to a good outcome.

Relevant Questions:

  • Does HIFU provide effective local tumor control and acceptable rates of remission and long-term disease-free survival in patients with localized prostate cancer?

  • Does HIFU provide acceptable outcomes with regard to urinary function, prostate outcomes, and sexual function?

  • How does HIFU compare with other primary treatment options for localized prostate cancer, including active surveillance?

  • Is HIFU safe, and what are the related complications?

  • Have definitive patient selection criteria been established for HIFU treatment for localized prostate cancer?

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