High-Intensity Focused Ultrasound focal therapy to primary treatment of localized prostate cancer
Type:Scientific Electronic Presentation
Authors: Ricardo Natel, Felipe Figueirôa, Giovana Helfenstein, Carolina Zaghini, Victor Jabour, Guilherme Mariotti, Antonio Rahal, Rodrigo Gobbo
Keywords:Prostate; High-Intensity Focused Ultrasound; Prostate Neoplasms; Focal Ablative Therapy; Magnetic Resonance Image.

The aim of this project is to identify candidates to HIFU FT (High-Intensity Focused Ultrasound focal therapy to primary treatment) for localized PCa (prostate cancer) that uses inclusion criteria such as Serum PSA (<15 ng/ml), Gleason score (ISUP 1-3), mpMRI with no extracapsular extension, no seminal vesicle invasion or pelvic lymph node disease and negative bone scintigraphy.


Material and methods

A single-center prospective analysis of initial 16 patients candidates for FT (hemigland or super-focal ablation) as the primary treatment option from August 2018 to March 2019.  All patients were re-evaluated by MRI and fusion prostate biopsy and following 68Ga-PSMA PET/RM to better understand the indication of HIFU before the procedure.



HIFU is an alternative to radical surgery or radiotherapy with fewer complications and similar oncological outcomes. 

The proposal is a focal ablative therapy. A non-invasive, radiation-free treatment using a robotic arm, with real time magnetic resonance image (MRI) trans-rectal ultrasound image fusion. It consists of a single-shot, but if needed can be repeated with non-cumulative effect. HIFU uses a focused beam of ultrasound waves that thermally ablate a selected portion of the prostate gland.

The mean prostate volume, age, PSA and region of interest volume were: 44.7cc, 65.1 years, 6.09 ng/dl and 0.97cm; respectively. Pre-procedure MRI showed 5.2% of PIRADS 2, 15.78% of PIRADS 3, 68.42% of PI RADS 4 and 10.52% of PIRADS 5. The biopsy showed 6 patients unilateral ISUP 1, 16 patients unilateral ISUP 2 and 6 patients ISUP 3. 

10 patients (62.5%) had...

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To sum up, 68Ga-PSMA PET/RM play a crucial role in the indication and planning of a focal ablative prostatic therapy and should be introduced in the inclusion criteria for cases indicated for HIFU.