Morphological analysis of the effects of intraoperative transrectal compression of the prostate during high‐intensity focused ultrasound for localized prostate cancer. (23rd March 2015)

• Record Type: Journal Article
• Authors: Shoji, Sunao; Hashimoto, Akio; Nakamoto, Masahiko; Fukuda, Norio; Fujikawa, Hiroshi; Endo, Kazuyuki; Tomonaga, Tetsuro; Nakano, Mayura; Terachi, Toshiro; Uchida, Toyoaki
• Is Part Of: International journal of urology. Volume 22:Number 6(2015)
• Page Start: 563
• Page End: 571
• Publication Date: 2015-03-23
• Subjects: Urology -- Periodicals; Genitourinary organs -- Periodicals; Urologic Diseases -- Periodicals; 616.6005
• DOI: 10.1111/iju.12747
• Languages: English
• ISSNs: 0919-8172

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="iju12747-sec-0001" sec-type="section"> <title>Objectives</title> <p>To evaluate the effects of transrectal compression of the prostate for intra‐operative prostatic swelling and intraprostatic point shift during high‐intensity focused ultrasound treatment of localized prostate cancer.</p> </sec> <sec id="iju12747-sec-0002" sec-type="section"> <title>Methods</title> <p>Patients treated with whole‐gland high‐intensity focused ultrasound as primary monotherapy for localized prostate cancer were enrolled in the study. Using the standard and compression method, the volumes of degassed water in the balloon covering the high‐intensity focused ultrasound probe were 50 mL and 80–160 mL, respectively. To identify prostatic swelling and shift during high‐intensity focused ultrasound and the volume occupied by the non‐enhanced area, three‐dimensional prostate models were reconstructed using ultrasound and contrast‐enhanced magnetic resonance imaging.</p> </sec> <sec id="iju12747-sec-0003" sec-type="section"> <title>Results</title> <p>In comparison with the standard (<italic>n</italic> = 40) and compression (<italic>n</italic> = 48) methods, intraoperative increase in the prostate volume (21% <italic>vs</italic> 5.3%; <italic>P</italic> = 0.044), intraprostatic point shift (4 mm <italic>vs</italic> 2 mm, <italic>P</italic> = 0.040 in the transition zone; 3 mm <italic>vs</italic> 0 mm; <italic>P</italic> = 0.001 in the peripheral zone) and the volume occupied by the non‐enhanced area (89% <italic>vs</italic> 96%; <italic>P</italic> = 0.001) were significantly suppressed. The biochemical disease‐free survival rate in patients treated using the compression method was significantly improved relative to the standard method (92.6% <italic>vs</italic> 76.5%; <italic>P</italic> = 0.038). Regarding complications, there was no significant difference in the rate of urethral stricture (<italic>P</italic> = 0.9), urinary tract infection (<italic>P</italic> = 0.9), incontinence (<italic>P</italic> = 0.3), erectile dysfunction (<italic>P</italic> = 0.9) or recto‐urethral fistula between the patients treated using the standard and compression methods.</p> </sec> <sec id="iju12747-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Intraoperative transrectal compression suppresses intraoperative increase in the prostate volume and intraprostatic point shift during high‐intensity focused ultrasound, having the potential to achieve precise whole‐gland and lesion‐targeted focal therapy.</p> </sec> </abstract>