An Evaluation of Henri-Ablation Therapy Using High-Intensity Focused Ultrasound in the Treatment of Localized Adenocarcinomaof the Prostate

摘要

The current choice for men with localised prostate cancer lies between active surveillance and radical therapy. The best evidence for the difference between these two extremes of care is 5% in terms of cancer-related absolute mortality at 8 years. It is generally accepted that this small difference will decrease for men diagnosed in the PSA-era.Therein lays a dilemma for men. If they choose active surveillance they accept anxiety of living with a cancer diagnosis and risk of under-treatment in the long term. On the other hand, radical therapy carries significant toxicity (incontinence, impotence, rectal problems) because it treats the whole gland and damages surrounding structures in up to half of men. With increasing PSA screening practices men are diagnosed younger with lower risk disease-early stage, lower Gleason grade and lower volume of cancer. Many have unifocal or unilateral disease.We propose a new concept whereby only the tumour focus and a margin of normal tissue is treated. With emerging techniques that can accurately localise tumour in the gland and technology that can treat to within millimetre accuracy, focal therapy of prostate cancer is now possible. By treating focally, the psychological burden of active surveillance is avoided. Equally, it is proposed that toxicity will decrease whilst at the same time retaining effective cancer control.