Clinically localised prostate cancer

This article is informative and very well illustrated, providing a
valuable overview of the treatment options available for clinically
localized prostrate cancer (1). However, there was unfortunately no
mention of High Intensity Focused Ultrasound (HIFU).This treatment option
can be offered to patients with localised prostate cancer (stage T1-T2) as
an alternative to surgery or to patients who are not ideal for a
prostatectomy (because of their age, their general state of being or other
co-morbidities). Furthermore, this treatment can be used in patients who
have local recurrence after external beam and interstitial radiotherapy.

HIFU destroys cancerous prostatic cells by coagulative necrosis (2)
without increasing metastasis formation (3). Unlike ionizing radiation,
cells in the entry and exit pathway of the HIFU beam are left uninjured.
This allows for multiple applications without increased risk to
neighbouring tissues. In March 2005, NICE (The National Institute for
Health and Clinical Excellence) issued guidance for doctors on HIFU for
prostate cancer. Contraindications for HIFU include; a prostate gland size
greater than 40cc, rectal stenosis, and a history of rectal fistula.

Although the clinical experience with HIFU is still limited, the
future of HIFU in the treatment of localized prostate cancer appears very
promising.

References:

1.Wilt TJ, Thompson IM. Clinically Localised Prostate Cancer. BMJ 2006;
333(7578):1102-6

2. Chapelon JY, Margonari J, Vernier F, Gorry F, Ecochard R, Gelet A. In
vivo effects of high-intensity ultrasound on prostatic adenocarcinoma
Dunning R3327. Cancer Res. 1992 Nov 15;52(22):6353-7.

3. Oosterhof GO, Cornel EB, Smith GA, et al. Influence of high-intensity
focused
ultrasound on the development of metastases. Eur Urol 1997; 32:91.

4. Azzouz H, de la Rosette JJMCH. HIFU: Local treatment of prostate
cancer. Eur Urol 2006;62-70.

Competing interests:
None declared