Transrectal high-intensity focused ultrasound for the treatment of localized prostate cancer

Authors: S. Thüroff;  C. G. Chaussy
Published in: Urol List 2014; 12(2): 6-18


Over the past 25 years, the average life expectancy for men has increased by four years, and the age of prostate cancer detection has decreased an average of 10 years with dia­gnosis increasingly made at early‑stage disease where curative therapy is possible. These changing trends in the age and extent of malignancy at dia­gnosis have revealed limitations in conventional curative therapies for prostate cancer, including a significant risk of aggressive cancer recurrence, and the risk of long‑term genitourinary morbidity and its detrimental impact on patient quality of life (QoL). Greater awareness of the shortcomings in radical prostatectomy, external radiotherapy and brachytherapy have prompted the search for alternative curative therapies that offer comparable rates of cancer control and less treatment‑related morbidity to better preserve QoL. High‑intensity focused ultrasound (HIFU) possesses characteristics that make it an attractive curative therapy option. HIFU is a non‑invasive approach that uses precisely‑ delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of prostate cancer, and is under experimental investigation for therapeutic use in renal and breast malignancies. Clinical research on HIFU therapy for localized prostate cancer began in the 1990s, and there have now been approximately 30,000 prostate cancer patients treated with HIFU, predominantly with the Ablatherm (EDAP TMS, Lyon, France) device. Transurethral resection of the prostate has been combined with HIFU since 2000 to reduce prostate size, facilitate tissue destruction, and to minimize side effects. Advances in imaging technologies are expected to further improve the already superior efficacy and morbidity outcomes, and ongoing investigation of HIFU as a focal therapy and in salvage and palliative indications are serving to expand the role of HIFU as a highly versatile non‑invasive therapy for prostate cancer.

Key words:
high-intensity focused ultrasound, prostate cancer, non-invasive, focal therapy, resistant to hormonal therapy


1. Chaussy CG, Thüroff S. Transrectal high‑intensity focused ultrasound for local treatment of prostate cancer: current role. Arch Esp Urol 2011; 64(6): 493– 506.

2. Chaussy C, Thüroff S. The status of high‑intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection. Curr Urol Rep 2003; 4(3): 248– 252.

3. Chaussy C, Thüroff S. Results and side effects of high‑intensity focused ultrasound in localized prostate cancer. J Endourol 2001; 15(4): 437– 440; discussion: 447– 448.

4. Chaussy CG, Thüroff S. The use of high‑intensity focused ultrasound in prostate cancer. In: Ukimura O, Gill IS (eds). Contemporary interventional ultrasonography in urology. London: Springer 2009: 63– 74.

5. Blana A, Murat FJ, Walter B et al. First analysis of the long‑term results with transrectal HIFU in patients with localised prostate cancer. Eur Urol 2008; 53(6): 1194– 1201.

6. Poissonnier L, Gelet A, Chapelon JY et al. Results of transrectal focused ultrasound for the treatment of localized prostate cancer (120 patients with PSA < or + 10 ng/ ml). Prog Urol 2003; 13(1): 60– 72.

7. Lynn JG, Putman TJ. Histology of cerebral lesions produced by focused ultrasound. Am J Pathol 1944; 20(3): 637– 649.

8. Ter Haar G. Intervention and therapy. Ultrasound Med Biol 2000; 26 (Suppl 1): S51– S54.

9. Chaussy CG, Thüroff SF. Robotic high‑intensity focused ultrasound for prostate cancer: what have we learned in 15 years of clinical use? Curr Urol Rep 2011; 12(3): 180– 187. doi: 10.1007/ s11934‑ 011‑ 0184‑ 2.

10. Chaussy C, Thüroff S. High‑intensity focused ultrasound in the management of prostate cancer. Expert Rev Med Devices 2010; 7(2): 209– 217. doi: 10.1586/ erd.09.66.

11. Chapelon JY, Margonari J, Theillère Y et al. Effects of high‑energy focused ultrasound on kidney tissue in the rat and the dog. Eur Urol 1992; 22(2): 147– 152.

12. Uchida T, Sanghvi NT, Gardner TA et al. Transrectal high‑intensity focused ultrasound for treatment of patients with stage T1b‑ 2n0m0 localized prostate cancer: a preliminary report. Urology 2002; 59(3): 394– 398; discussion: 398– 399.

13. Chapelon JY, Cathignol D, Cain C et al. New piezoelectric transducers for therapeutic ultrasound. Ultrasound Med Biol 2000; 26(1): 153– 159.

14. Curiel L, Chavrier F, Souchon R et al. 1.5– D high intensity focused ultrasound array for non‑invasive prostate cancer surgery. IEEE Trans Ultrason Ferroelectr Freq Control 2002; 49(2): 231– 242.

15. Tan JS, Frizzell LA, Sanghvi NT et al. Design of focused ultrasound phased array for prostate treatment. Proc IEEE Ultrason Symp 2000: 1247– 1251.

16. Oosterhof GO, Cornel EB, Smits GA et al. Influence of high‑intensity focused ultrasound on the development of metastases. Eur Urol 1997; 32(1): 91– 95.

17. Foster RS, Bihrle R, Sanghvi N et al. Production of prostatic lesions in canines using transrectally administered high‑intensity focused ultrasound. Eur Urol 1993; 23(2): 330– 336.

18. Gelet A, Chapelon JY, Margonari J et al. Prostatic tissue destruction by high‑intensity focused ultrasound: experimentation on canine prostate. J Endourol 1993; 7(3): 249– 253.

19. Chaussy C, Thüroff S, Rebillard X et al. Technology insight: High‑intensity focused ultrasound for urologic cancers. Nat Clin Pract Urol 2005; 2(4): 191– 198.

20. Rébillard X, Davin JL, Soulié M. Treatment by HIFU of prostate cancer: survey of literature and treatment indications. Prog Urol 2003; 13(6): 1428– 1456.

21. Chaussy CG, Thüroff S. Robot‑ assisted high‑intensity focused ultrasound in focal therapy of prostate cancer. J Endourol 2010; 24(5): 843– 847. doi: 10.1089/ end.2009.0439.

22. Misonix/ U.S. HIFU. HIFU with the Sonablate 5000. [online]. Available from: http:/ /

23. Beerlage HP, van Leenders GJ, Oosterhof GO 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– 46.

24. Rouviere O, Lyonnet D, Raudrant A et al. MRI appearance of prostate following transrectal HIFU ablation of localized cancer. Eur Urol 2001; 40(3): 265– 274.

25. Hynynen K, Freund WR, Cline HE et al. A clinical, noninvasive, MR imaging‑ monitored ultrasound surgery method. Radiographics 1996; 16(1): 185– 195.

26. Damianou C, Pavlou M, Velev O et al. High intensity focused ultrasound ablation of kidney guided by MRI. Ultrasound Med Biol 2004; 30(3): 397– 404.

27. Wu T, Felmlee JP, Greenleaf JF et al. Assessment of thermal tissue ablation with MR elastography. Magn Reson Med 2001; 45(1): 80– 87.

28. Vaezy S, Shi X, Martin RW et al. Real‑ time visualization of high‑intensity focused ultrasound treatment using ultrasound imaging. Ultrasound Med Biol 2001; 27(1): 33– 42.

29. Sedelaar JP, Aarnink RG, van Leenders GJ et al. The application of three‑ dimensional contrast‑ en­hanced ultrasound to measure volume of affected tissue after HIFU treatment for localized prostate cancer. Eur Urol 2000; 37(5): 559– 568.

30. Lu J, Ying H, Sun Z et al. In vitro measurement of speed of sound during coagulate tissue heating. Ultrasonics Symp Proc IEEE 1996; 2: 1299– 1302.

31. Gelet A, Chapelon JY, Poissonnier L et al. Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high‑intensity focused ultrasonography. Urology 2004; 63(4): 625– 629.

32. Chaussy C, Thüroff S. Complete remission in metastatic prostate cancer after combined local and systemic therapy. Urology 2006; 68: 197– 198.

33. Ficarra V, Antoniolli SZ, Novara G et al. Short‑term outcome after high‑intensity focused ultrasound in the treatment of patients with high‑risk prostate cancer. BJU Int 2006; 98(6): 1193– 1198.

34. Consensus statement: guidelines for PSA fol­lowing radiation therapy. Society for Therapeutic Radiology and Oncology Consensus Panel. Int J Radiat Oncol Biol Phys 1997; 37(5): 1035– 1041.

35. Chaussy CG, Thüroff S. Transrectal high‑intensity focused ultrasound for local treatment of prostate cancer. Urologe A 2009; 48(7): 710– 718. doi: 10.1007/ s00120‑ 009‑ 1981‑ 9.

36. Vallancien G, Prapotnich D, Cathelineau X et al. Transrectal focused ultrasound combined with transurethral resection of the prostate for the treatment of localized prostate cancer: feasibility study. J Urol 2004; 171(6 Pt 1): 2265– 2267.

37. Agarwal PK, Sadetsky N, Konety BR et al. Treatment failure after primary and salvage therapy for prostate cancer: likelihood, patterns of care, and outcomes. Cancer 2008; 112(2): 307– 314.

38. Gelet A, Chapelon JY, Bouvier R et al. Treatment of prostate cancer with transrectal focused ultrasound: early clinical experience. Eur Urol 1996; 29(2): 174– 183.

39. Gelet A, Chapelon JY, Bouvier R et al. Local con­trol of prostate cancer by transrectal high intensity focused ultrasound therapy: preliminary results. J Urol 1999; 161(1): 156– 162.

40. Gelet A, Chapelon JY, Bouvier R et al. Transrectal high‑intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. J Endourol 2000; 14(6): 519– 528.

41. Richaud P, Moreau JL, Beuzeboc P et al. Follow‑up of prostate cancer. Guidelines of the Comité de Cancérologie de l‘Association Française d‘Urologie. Prog Urol 2005; 15(4): 586– 592.

42. Gelet A, Chapelon JY, Bouvier R et al. Transrectal high intensity focused ultrasound for the treatment of localized prostate cancer: factors influencing the outcome. Eur Urol 2001; 40(2): 124– 129.

43. Blana A, Rogenhofer S, Ganzer R et al. Eight years’ experience with high‑intensity focused ultrasonography for treatment of localized prostate cancer. Urology 2008; 72(6): 1329– 1333; discussion 1333– 4. doi: 10.1016/ j.urology.2008.06.062.

44. Poissonnier L, Chapelon JY, Rouviēre O et al. Control of prostate cancer by transrectal HIFU in 227 patients. Eur Urol 2007; 51(2): 381– 387.

45. Blana A, Brown SC, Chaussy C et al. Primary prostate HIFU without pretreatment hormone therapy: bio­chemical survival of 763 patients tracked with the @– Registry. Eur Urol 2009; 8(4): 333.

46. D’Amico AV, Moul J, Carroll PR et al. Cancer‑ specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed dur­ing the prostate‑ specific antigen era. J Clin Oncol 2003; 21(11): 2163– 2172.

47. Ganzer R, Rogenhofer S, Walter B et al. PSA nadir is a significant predictor of treatment failure after high‑intensity focused ultrasound (HIFU) treatment of localised prostate cancer. Eur Urol 2008; 53(3): 547– 553.

48. Thüroff S, Chaussy C, Vallancien G et al. High‑intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. J Endourol 2003; 17(8): 673– 677.

49. Kupelian PA, Elshaikh M, Reddy CA et al. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate‑ specific antigen era: a large single‑institution experience with radical prostatectomy and external‑ beam radiotherapy. J Clin Oncol 2002; 20(16): 3376– 3385.

50. Kuban DA, Thames HD, Levy LB et al. Long‑term multi‑institutional analysis of stage T1– T2 prostate cancer treated with radiotherapy in the PSA era. Int J Radiat Oncol Biol Phys 2003; 57(4): 915– 928.

51. Potters L, Klein EA, Kattan MW et al. Monotherapy for stage T1– T2 prostate cancer: radical prostatectomy, external beam radiotherapy, or permanent seed implantation. Radiother Oncol 2004; 71(1): 29– 33.

52. Crouzet S, Rebillard X, Chevallier D et al. Multicentric oncologic outcomes of high‑intensity focused ultrasound for localized prostate cancer in 803 patients. Eur Urol 2010; 58(4): 559– 566. doi: 10.1016/ j.eururo.2010.06.037.

53. Chaussy CG, Thüroff S. High‑intensive focused ultrasound in localized prostate cancer. J Endourol 2000; 14(3): 293– 299.

54. Thüroff S, Chaussy C. High‑intensity focused ultrasound: complications and adverse events. Mol Urol 2000; 4(3): 183– 187.

55. Thüroff S. High‑intensity focused ultrasound for prostate cancer. In: Su LM and Young CS (eds). Early dia­gnosis and treatment of cancer: prostate cancer. Philadelphia: Elsevier Saunders 2008: 177– 192.

56. Thüroff S, Chaussy C, Gelet A. Focused ultrasound (HIFU) in the treatment of prostate cancer. Energy/ efficacy correlation. WCE Congress, 2001. J Endourol 2001; 15 (1 Suppl): S32.

57. Chaussy CG, Thueroff SF. HIFU treatment of locally advanced prostate cancer. J Endourol 2010; 24 (1 Suppl): PS12– 2.

58. Chaussy C, Thuroff S, Nanieva R. Hormone resistant prostate cancer treated by robotic high intensive ultrasound. J Urol 2010; 183 (Suppl): e262.

59. Chaussy C, Thüroff S, Bergsdorf T. Local recur­rence of prostate cancer after curative therapy. HIFU (Ablatherm) as a treatment option. Urologe A 2006; 45(10): 1271– 1275.

60. Murat FJ, Poissonnier L, Rabilloud M et al. Mid‑term results demonstrate salvage high‑intensity focused ultrasound (HIFU) as an effective and acceptably morbid salvage treatment option for locally radiorecurrent prostate cancer. Eur Urol 2009; 55(3): 640– 647. doi: 10.1016/ j.eururo.2008.04.091.

61. Berge V, Baco E, Karlsen SJ. A prospective study of salvage high‑intensity focused ultrasound for locally radiorecurrent prostate cancer: early results. Scand J Urol Nephrol 2010; 44(4): 223– 227. doi: 10.3109/ 00365591003727551.

62. Hayashi M, Shinmei S, Asano K. Transrectal high‑intensity focused ultrasound for treatment for patients with bio­chemical failure after radical prostatectomy. Int J Urol 2007; 14(11): 1048– 1050.

63. Marberger M. Prostate cancer 2008. Challenges in dia­gnostic and management. Europ Urol 2009; 8 (3 Suppl): 1989– 1996.

64. Van Leeuwen PJ, Connolly D, Tammela TL et al. Balancing the harms and benefits of early detection of prostate cancer. Cancer 2010; 116(20): 4857– 4865. doi: 10.1002/ cncr.25474.

65. Klotz L. Active surveillance for Prostate Cancer: For whom? J Clin Oncol 2005; 23(32): 8165– 8169.

66. Roemeling S, Roobol MJ, Kattan MW et al. Nomogram use for the prediction of indolent prostate cancer: impact on screen‑ detected populations. Cancer 2007; 110(10): 2218– 2221.

67. Onik G, Barzell W. Transperineal 3D mapping bio­psy of the prostate: an essential tool in selecting patients for focal prostate cancer therapy. Urol Oncol 2008; 26(5): 506– 510. doi: 10.1016/ j.urolonc.2008.03.005.

68. Rouviēre O, Souchon R, Salomir R et al. Transrectal high‑intensity focused ultrasound ablation of prostate cancer: effective treatment requiring accurate imaging. Eur J Radiol 2007; 63(3): 317– 327.

69. Kirkham AP, Emberton M, Allen C. How good is MRI at detecting and characterising cancer within the prostate? Eur Urol 2006; 50(6): 1163– 1174.

70. Kim JK, Hong SS, Choi YJ et al. Wash‑ in rate on the basis of dynamic contrast‑ enhanced MRI: usefulness for prostate cancer detection and localization. J Magn Reson Imaging 2005; 22(5): 639– 646.

71. Haider MA, van der Kwast TH, Tanguay J et al. Combined T2– weighted and diffusion‑ weighted MRI for localization of prostate cancer. Am J Roentgenol 2007; 189(2): 323– 328.

72. Uchida T, Illing RO, Cathcart PJ et al. To what extent does the prostate‑ specific antigen nadir predict subsequent treatment failure after transrectal high‑intensity focused ultrasound therapy for pre­sumed localized adenocarcinoma of the prostate? BJU Int 2006; 98(3): 537– 539.

73. Wu F, Wang ZB, Lu P et al. Activated anti‑tumor immunity in cancer patients after high intensity focused ultrasound ablation. Ultrasound Med Biol 2004; 30(9): 1217– 1222.

74. Wu F, Wang ZB, Cao YD et al. Expression of tumor antigens and heat‑ shock protein 70 in breast cancer cells after high‑intensity focused ultrasound ablation. Ann Surg Oncol 2007; 14(3): 1237– 1242.

75. Hu Z, Yang XY, Liu Y et al. Investigation of HIFU‑induced anti‑tumor immunity in a murine tumor model. J Transl Med 2007; 5: 34.

76. Lu P, Zhu XQ, Xu ZL et al. Increased infiltration of activated tumor‑ infiltrating lymphocytes after high intensity focused ultrasound ablation of human breast cancer. Surgery 2009; 145(3): 286– 293. doi: 10.1016/ j.surg.2008.10.010.

77. Lee HM, Hong JH, Choi HY. High‑intensity focused ultrasound therapy for clinically localized prostate cancer. Prostate Cancer Prostatic Dis 2006; 9(4): 439– 443.

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