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Hochintensiver fokussierter Ultraschall (HIFU)

Stellenwert bei der Therapie des Prostatakarzinoms

High intensity focused ultrasound (HIFU)

Importance in the treatment of prostate cancer

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Zusammenfassung

Hintergrund

Hochintensiver fokussierter Ultraschall (HIFU) wird seit Anfang der 90er Jahre als alternative Behandlungsform beim Prostatakarzinom eingesetzt.

Ziel der Arbeit

Übersicht über den aktuellen Stand und kritische Betrachtung der verschiedenen Indikationen des HIFU beim Prostatakarzinom.

Material und Methoden

Review der aktuellen Literatur zu Indikationen, Nebenwirkungen, onkologischen Ergebnissen und Leitlinienempfehlungen.

Ergebnisse

Das Prinzip basiert auf hochenergetischen Schallwellen, die durch Fokussierung zu einer Koagulationsnekrose führen. HIFU kann in unterschiedlichen Indikationen eingesetzt werden: beim Whole-gland-HIFU (Behandlung der kompletten Prostata) wird in der Primärtherapie des lokal begrenzten Prostatakarzinoms eine Ablation des kompletten Prostatagewebes angestrebt. Es liegen mehrere Fallserien mit einem maximalen medianen Follow-up von 8,1 Jahren vor. Die Hauptnebenwirkung ist die Ausbildung einer Blasenhalssklerose. Eine weitere Indikation ist der Salvage-HIFU bei Patienten mit Lokalrezidiv nach primärer Strahlentherapie. Aufgrund des erhöhten Risikos einer Inkontinenz sowie rektourethralen Fistelbildung muss die Indikation vorsichtig gestellt werden. Als innovative Feld gilt die fokale Therapie, bei welcher mithilfe des HIFU eine Teilbehandlung des tumortragenden Anteils der Prostata erfolgt. Durch technische Weiterentwicklungen ist eine Therapieplanung mit Fusion eines multiparametrischen Magnetresonanztomogramms (mpMRT) möglich. Aufgrund des experimentellen Charakters soll diese Therapieform in Studien erfolgen.

Diskussion

Aufgrund fehlender prospektiv randomisierter Studien sowie limitierter Langzeitdaten wird der Whole-gland-HIFU in den Leitlinien europäischer Länder unterschiedlich bewertet. Die fokale Therapie gilt als experimentell und soll daher nur in Studien durchgeführt werden.

Abstract

Background

High intensity focused ultrasound (HIFU) has been used since the beginning of the 1990s as an alternative treatment for prostate cancer.

Objective

Overview of the current status and critical review of the different indications for HIFU in the treatment of prostate cancer.

Material and methods

Review of the current literature on the indications, side effects, oncologic results and current guideline recommendations.

Results

The principle of HIFU is based on high energy sound waves, which lead to coagulation necrosis at the focal point. It can be applied for different indications: complete ablation of prostatic tissue is attempted in whole gland HIFU in the primary treatment of localized prostate cancer. There are several case series in the current literature with a maximum median follow-up of 8.1 years. The main side effect is the formation of bladder neck sclerosis. A further indication is for salvage HIFU in patients with localized recurrent prostate cancer after radiotherapy. This is a high-risk procedure due to increased risk of incontinence and formation of rectourethral fistula. Focal therapy is an innovative field aiming at partial prostate gland ablation with HIFU thereby reducing side effects. Technical improvements in HIFU enable treatment planning with fusion of multiparametric magnetic resonance imaging (mpMRI). Due to the experimental character, this should only be carried out within clinical trials.

Discussion

Due to a lack of prospective randomized trials and limited long-term results, whole gland HIFU is considered differently in the guidelines of European countries. Focal therapy is still experimental and should only be carried out within clinical trials.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland

    R. Ganzer FEBU

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Correspondence to R. Ganzer FEBU.

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R. Ganzer gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Ganzer, R. Hochintensiver fokussierter Ultraschall (HIFU). Radiologe 57, 659–664 (2017). https://doi.org/10.1007/s00117-017-0245-8

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  • DOI: https://doi.org/10.1007/s00117-017-0245-8

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