Magnetic resonance imaging of the prostate after focal therapy with high-intensity focused ultrasound
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REVIEW
Magnetic resonance imaging of the prostate after focal therapy with high‑intensity focused ultrasound Soleen Ghafoor1,2 · Anton S. Becker1,2 · Daniel Stocker2,3 · Borna K. Barth2 · Daniel Eberli4 · Olivio F. Donati2 · Hebert Alberto Vargas1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract For clinically significant, locally confined prostate cancer, whole-gland radical prostatectomy and radiotherapy are established effective treatment strategies that, however, come at a cost of significant morbidity related to urinary and sexual side effects. The concept of risk stratification paired with a better understanding of prognostic factors has led to the development of alternative management options including active surveillance and focal therapy for appropriately selected patients with localized disease. High-intensity focused ultrasound (HIFU) is one such minimally invasive, image-guided treatment option for prostate cancer. Due to the relative novelty of HIFU and the increased use of magnetic resonance imaging in prostate cancer, many radiologists are not yet familiar with imaging findings related to HIFU, their temporal evolution as well as imaging appearance of recurrent disease after this type of focal therapy. HIFU induces sharply demarcated, localized coagulative necrosis of a tumor through thermal energy delivered via an endorectal or transurethral ultrasound transducer. In this pictorial review, we aim at providing relevant background information that will guide the reader through the general principles of HIFU in the prostate, as well as demonstrate the imaging appearance of expected post-HIFU changes versus recurrent tumor. Keywords Magnetic resonance imaging · High-intensity focused ultrasound · Prostate cancer · Focal therapy
Introduction
Soleen Ghafoor, Anton S. Becker, Olivio F. Donati, and Hebert Alberto Vargas have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00261-020-02577-5) contains supplementary material, which is available to authorized users. * Soleen Ghafoor [email protected] 1
Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York 10065, USA
2
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
3
BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York 10029, USA
4
Department of Urology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
Radical prostatectomy and external beam radiotherapy are still considered the “gold-standard” for treatment of prostate cancer with availability of robust long-term oncologic outcome data [1]. However, their associated morbidity (e.g., urinary incontinence, erectile dysfunction, post-radiation proctitis) [2, 3] combined with a better understanding of risk stratification in prostate cancer have led to a surge of alternative treat
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