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Morphological analysis of the effects of intraoperative transrectal compression of the prostate during high‐intensity focused ultrasound for localized prostate cancer
Author(s) -
Shoji Sunao,
Hashimoto Akio,
Nakamoto Masahiko,
Fukuda Norio,
Fujikawa Hiroshi,
Endo Kazuyuki,
Tomonaga Tetsuro,
Nakano Mayura,
Terachi Toshiro,
Uchida Toyoaki
Publication year - 2015
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12747
Subject(s) - medicine , prostate , prostate cancer , urology , magnetic resonance imaging , ultrasound , high intensity focused ultrasound , lower urinary tract symptoms , intensity (physics) , balloon , cancer , nuclear medicine , radiology , surgery , physics , quantum mechanics
Objectives 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. Methods 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. Results In comparison with the standard ( n = 40) and compression ( n = 48) methods, intraoperative increase in the prostate volume (21% vs 5.3%; P = 0.044), intraprostatic point shift (4 mm vs 2 mm, P = 0.040 in the transition zone; 3 mm vs 0 mm; P = 0.001 in the peripheral zone) and the volume occupied by the non‐enhanced area (89% vs 96%; P = 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% vs 76.5%; P = 0.038). Regarding complications, there was no significant difference in the rate of urethral stricture ( P = 0.9), urinary tract infection ( P = 0.9), incontinence ( P = 0.3), erectile dysfunction ( P = 0.9) or recto‐urethral fistula between the patients treated using the standard and compression methods. Conclusions 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.