Focused Ultrasound Therapy of the Prostate with MR Guidance
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MINIMAL INVASIVE PROCEDURES & HIGH FREQUENCY FOCUSED ULTRASOUND (WM GEDROYC, SECTION EDITOR)
Focused Ultrasound Therapy of the Prostate with MR Guidance Alessandro Napoli • Gaia Cartocci • Fabrizio Boni • Maurizio Del Monte • Vincenzo Noce • Michele Anzidei • Carlo Catalano
Published online: 22 February 2013 Springer Science+Business Media New York 2013
Abstract Prostate cancer (PC) is one of the most common cancers in the male population worldwide. Focal therapy for PC is now considered an emerging alternative to active surveillance for the management of low-risk PC, with the overall aim of treating only areas of cancer, minimizing lifetime morbidity without compromising life expectancy. One option within focal therapy, high intensity focused ultrasound (HIFU), represents an innovative technique that may selectively ablate known the disease while preserving existing functions. In the last 10 years, the feasibility and the safety of US guided HIFU has been tested in a growing number of clinical studies. More recently, magnetic resonance imaging was combined with HIFU principle and was presented as a novel technique for focal ablation of PC. In this review we introduce the technology of Magnetic Resonance guided Focused
A. Napoli (&) G. Cartocci F. Boni M. Del Monte V. Noce M. Anzidei C. Catalano Department of Radiology, Oncology and Anatomic Pathology, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy e-mail: [email protected] G. Cartocci e-mail: [email protected] F. Boni e-mail: [email protected] M. Del Monte e-mail: [email protected] V. Noce e-mail: [email protected] M. Anzidei e-mail: [email protected] C. Catalano e-mail: [email protected]
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Ultrasound (MRgFUS) and the current status of clinical applications in the therapy of PC. Keywords Prostate cancer MR guided focused ultrasound MRgFUS High intensity focused ultrasound HIFU Focal therapy
Introduction Prostate cancer (PC) is recognized as one of the most common cancer in males all over the world, with recent statistics reporting an incidence of 30 % in the United States over the last year [1]. The introduction of prostatespecific antigen (PSA) testing has nearly doubled the lifetime risk of receiving a diagnosis of PC and has led to a decrease in cancer mortality [2]. D’Amico et al. developed the concept of risk stratification, which provides for the classification of men into low, intermediate, and high-risk pretreatment groups using a combination of clinical data: PSA, Gleason sum, and clinical stage (Table 1). Currently, the treatment of low risk PC remains controversial [3]; approximately 29 % of patient are referred to active surveillance, 33 % to radiotherapy and 39 % to radical prostatectomy (RP) [4]. In most of the cases, RP is curative and in several centers represents the first-line treatment choice, even if associated with higher morbidity as compared to other therapeutic options [5]. Recently, treatment approaches that
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