Investig Clin Urol.  2019 Jul;60(4):312-318. 10.4111/icu.2019.60.4.312.

A structured framework for optimizing high-intensity focused ultrasound ablative treatment in localized prostate cancer

• Castellani D
• Branchi A
• Claudini R
• Gasparri L
• Pierangeli T
• Ravasi E
• Dellabella M

• KMID: 2450549
• DOI: http://doi.org/10.4111/icu.2019.60.4.312

Abstract

High-intensity focused ultrasound (HIFU) treatment has recently been pursued to reduce radical treatment-related morbidity in low-to-intermediate-risk localized prostate cancer (PCa), especially in older men. The aim of this study was to develop a dedicated framework for HIFU therapy. All clinical data, such as risk categories, magnetic resonance with functional parametric imaging, and histopathology, are essential for driving proper HIFU treatment. All needed data can be added to the framework to localize areas that need to be treated. Once PCa areas have been featured, quantified, and located, planning can be adapted to drive accurate HIFU treatment. Our planning framework may be useful for all ablative therapies in order to standardize treatment for both clinical and scientific purposes.

Keyword

Ablation techniques; High-intensity focused ultrasound ablation; Planning techniques; Prostatic neoplasms

MeSH Terms

Ablation Techniques
High-Intensity Focused Ultrasound Ablation
Humans
Male
Passive Cutaneous Anaphylaxis
Planning Techniques
Prostate*
Prostatic Neoplasms*
Ultrasonography*

Figure

• 

  Fig. 1 (A) Prostate cancer localization: clinical, biopsy, and multiparametric magnetic resonance (mpMR) imaging data have to be dotted in 27 sectors according to Dickinson et al. [9]. (B) High-intensity focused ultrasound (HIFU) preplanning: mpMR lesions and biopsy findings are both dotted in the plan. Their localization drives ablation in radical (whole gland) or partial (target, quadrantectomy, hemiablation, zonal) treatment. Picture modified with permission from Dickinson et al. [9]. PSA, prostate-specific antigen; TRUS, transrectal ultrasound; SV, seminal vesicles.

• 

  Fig. 2 Target ablation. (A) Red circles: localization of one PI-RADS v2 score 4 lesion found at multiparametric magnetic resonance (mpMR). Blue circles: cancer core localization. (B) Green area encloses ablation target. PI-RADS, Prostate Imaging–Reporting and Data System; PSA, prostate-specific antigen; TRUS, transrectal ultrasound; HIFU, high-intensity focused ultrasound; SV, seminal vesicles.

• 

  Fig. 3 Right quadrantectomy, middle-apex. (A) Red circles: localization of one PI-RADS v2 score 4 lesion in the transitional zone found at multiparametric magnetic resonance (mpMR). Blue circles: cancer core localization. (B) Green area encloses ablation target. PI-RADS, Prostate Imaging–Reporting and Data System; PSA, prostate-specific antigen; TRUS, transrectal ultrasound; HIFU, high-intensity focused ultrasound; SV, seminal vesicles.

• 

  Fig. 4 Left hemiablation. (A) Red circles: localization of three PI-RADS v2 score 4 lesions found at multiparametric magnetic resonance (mpMR). Blue circles: cancer core localization. (B) Green area encloses ablation target. PI-RADS, Prostate Imaging–Reporting and Data System; PSA, prostate-specific antigen; TRUS, transrectal ultrasound; HIFU, high-intensity focused ultrasound; SV, seminal vesicles.

• 

  Fig. 5 Zonal ablation. (A) Red circles: localization of one PI-RADS v2 score 5 lesion found at multiparametric magnetic resonance (mpMR). Blue circles: cancer core localization. (B) Green area encloses ablation target (hockey stick). PI-RADS, Prostate Imaging–Reporting and Data System; PSA, prostate-specific antigen; TRUS, transrectal ultrasound; HIFU, high-intensity focused ultrasound; SV, seminal vesicles.

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