Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Endourol. 2021 Sep;35(S2):S24-S32. doi: 10.1089/end.2020.1161.
With the advancement of early detection tools for prostate cancer and ability to better localize disease, there has been increased interest in focal or targeted therapies that carry less morbidity than traditional whole-gland treatments. The Sonablate high-intensity focused ultrasound (HIFU) device has Food and Drug Administration (FDA) 510(K) clearance in the United States for ablation of prostate tissue. HIFU utilizes an ultrasound (US) transducer that focuses US beams on a preset point as much as 4 cm from the energy source without injuring intervening tissue. The Sonablate system guides the surgeon step-by-step to perform effective ablation of a target lesion. The surgeon can assess treatment effect with tissue change monitoring, and care is taken to prevent rectal wall injury. We believe hemiablation is the most favorable focal HIFU treatment to optimize cancer control and minimize the side effects associated with whole gland therapy. We recommend considering HIFU ablation as an extension of active surveillance rather than definitive treatment. Further research on long-term oncologic and functional outcomes is warranted.
随着前列腺癌早期检测工具的进步和对疾病定位能力的提高，人们对局部或靶向治疗的兴趣日益增加，因为这些治疗方法的发病率比传统的全腺体治疗方法要低。美国 Sonablate 高强度聚焦超声（HIFU）设备已获得美国食品和药物管理局（FDA）510(K)许可，可用于消融前列腺组织。HIFU 利用超声（US）换能器将 US 束聚焦在离能量源 4cm 以内的预设点上，而不会损伤 intervening 组织。Sonablate 系统可引导外科医生逐步对目标病变进行有效的消融。外科医生可以通过组织变化监测来评估治疗效果，并注意防止直肠壁损伤。我们认为，半消融是最有利的局部 HIFU 治疗方法，可以优化癌症控制，最大限度地减少与全腺体治疗相关的副作用。我们建议将 HIFU 消融作为主动监测的一种延伸，而不是确定性治疗。有必要对长期肿瘤学和功能结果进行进一步研究。
