Focused ultrasounds
What is a treatment by focalized high intensity ultrasounds?
A treatment by focalized high intensity ultrasounds has for main goal to locally destroy the prostate and the tumor, by heat. It is a local treatment for non metastatic prostate cancer, meaning it allows action directly on the prostate and killing the tumor.
It is also called Albatherm (brand name of the technique) The treatment by focalized high intensity ultrasounds is being studied to be suggested to patients with non metastatic prostate cancer. It is done by a urologist.
The treatment by focalized high intensity ultrasounds can only be done by professional health care trained in this technique.
Only few places in France have this technique available: only 4 centres permanently have the material required, 13 have a mobile version.
What is the principle behind treatment by ultrasounds?
It uses ultrasound emitted by an endo-rectal probe, introduced into the rectum. The port is covered with a small balloon filled with frozen liquid that allows the wall of the rectum to stay at a constant temperature during the entire treatment.
The port allows visualisation of the prostate (imaging port) and its treatment (treating port) The ultrasound beam focalized on the prostate is emitted as shots lasting 5 seconds. Those shots lead to a sudden increase in temperature in the zone being treated, which leads to irreversible destruction of tissues.
Each shot destroys a small zone of the prostate of 22mm in length and 2mm in diameter. By moving the port between each impulsions and repeating the ultrasound shots, it is possible to destroy the entire prostate volume. Three to Four hundred shots are necessary to treat the entire prostate. The number of shots depends on the prostate volume.
How does the treatment by ultrasounds occur?
The treatment by focalized high intensity ultrasounds is done after a bowel preparation that aims at emptying the rectum before the treatment. The procedure is usually realized under loco-regional anesthesia: only the specific zone is anesthetized. It can also occur under generalized anesthesia. The patient is lying down on his right side. Once the port is introduced into the rectum, the surgeon detects the limits of the prostate through the endo-rectal ultrasound.
Then he successively defines the various targeted zones (4 to 6) that will then be treated. The entire prostate is treated, because the cancer affects many zones in more than 85% of cases. In general, the central part of the prostate is removed a few days before or during the same anesthesia. The duration of the treatment is between 1 to 3 hours depending on the volume of the prostate. This procedure is not painful. At the end of the treatment, a foley catheter is placed.
In general it is removed 3 days later. When it is necessary to keep it for a longer time, the patient can go home with the foley and come back for 24 to 48 hours of hospitalization in order to remove it and evaluate at the same time possible urinary leaks.
Avantages de la technique
It is a short treatment (generally on session only) that usually does not require general anesthesia. The hospital stay is short: the patient comes the night before the treatment, bowel prep is done. After the actual treatment a port is put in place. It is usually removed 2 days later. The patient stays one extra day in the hospital for observation. In total he spends 5 nights in the hospital.
What are the disadvantages of the treatment?
Side effects can appear at the end of the treatment. There are two types of side effects: Immediate ones: for the first 2 month following the treatment, some patients may present with urinary troubles such as frequency, urgency with leaks, urinary infection without fever, minimal bleeding or urinary excretion of destroyed tissues. These side effects are usually minor and disappear rapidly. Late side effects: complications are rare. The main risks are urinary incontinence during an effort (less than 10% of cases) and urethra shrinking (8% of cases) The rate of impotence depends on the age and the technique used.
What is the follow up after the treatment?
After a treatment with focalized high intensity ultrasounds, PSA levels and biopsies done 6 months after the treatment, allow follow up of the patient. The treatment can be repeated if cancerous cells are detected by control biopsies. This occurs in 20% of the patients. A second session is done within the 2 months that follow the control biopsy. After a treatment with ultrasound, external radiotherapy can also be suggested. Ultrasound treatment after failure of external radiotherapy is being investigated.
Who could get a treatment by high intensity ultrasound?
In December 2003, The French Association of Urology (AFU) decided that this treatment should take into account the age of the patient as well as characteristics of the tumor and the prostate. This treatment is now offered essentially to men under 70 years old, or presenting with other disease that would render this procedure risky or impossible (morbidly obese, respiratory failure, cardiac problems) This treatment is offered only I situations where the cancer is localized and the PSA value is below 15ng/ml.
What are the results obtained by such a treatment?
The long term results are not yet known, whereas long term results of other treatment for prostate cancer are know (surgery..) Due to the lack of clinical studies on this technique, we still do not know is this treatment is equivalent to the others. For more information, do not hesitate to contact your doctor.
