PURPOSE: To quantify prostatic swelling and shift of intra-prostatic points during HIFU using real-time ultrasound.
MATERIALS AND METHODS: The institutional review board approved this retrospective study. Forty-four patients with clinically localized prostate cancer underwent whole gland HIFU. Three sessions of HIFU were required to cover the entire prostate; anterior zone (1st-session), middle zone (2nd-session), and posterior zone of the prostate (3rd-session). Computer-assisted 3D reconstructions based on 3mm step-sectional images of intra-operative transrectal ultrasound were compared before and after each session.
RESULTS: Most of the prostate swelling and shift of intra-prostatic points occurred during the 1st-session, with median percent increase in volume of 18% for the transition zone (TZ), 9% for the peripheral zone (PZ), and 13% for the entire prostate. The percent increase in TZ volume (p< 0.001), PZ volume (p=0.001), and the entire prostate volume (p=0.001) were statistically dependent on the volume of each measured pre-operatively. Median 3D intra-prostatic shift was 3.7 mm (range: 0.9-13 mm) in the TZ, and 5.5 mm (range: 0.2-14 mm) in the PZ. Significant negative linear correlation was found between the pre-operative presumed circle area ratio (PCAR) and percent increase in prostate volume (p=0.001) and shift (p=0.01) during HIFU.
CONCLUSIONS: Significant prostatic swelling and shift of the prostate were quantified during HIFU. Smaller prostates and smaller PCAR were associated with larger prostatic swelling and intra-prostatic shifts. Real-time intra-operative adjustment of the treatment plan has an impact on achieving precise targeting during HIFU especially in the prostate with smaller volume and/or smaller PCAR.
Written by:
Shoji S, Uchida T, Nakamoto M, Kim H, de Castroabreu AL, Leslie S, Sato Y, Gill IS, Ukimura O. Are you the author?
USC Institute of Urology, Hillard and Roclyn Herzog Center for Prostate Cancer Focal Therapy, Keck School of Medicine, University of Southern California, Los Angeles, USA; Department of Urology, Tokai University Hachioji Hospital, Hachioji, Japan.
Reference: J Urol. 2013 Apr 9. pii: S0022-5347(13)04025-1.
doi: 10.1016/j.juro.2013.03.116
PubMed Abstract
PMID: 23583532
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