Prostat kanserlerinin tedavisinde HİFU’nun yeri HIFU (Yüksek Yoğunluklu Odaklanmış Ultrason)

Güncel tedavi kılavuzlarında prostat kanserli hastalarda, radikal prostatektomi ve radyoterapi önerilen standart tedavi modaliteleridir. 1980’li yıllarda piezoelektrik kaynakların dokularda meydana getirdiği biyolojik etkilerin anlaşılmasıyla birlikte prostat kanserinde yeni bir tedavi modalitesi olarak yüksek yoğunluklu odaklanmış ultrason (HIFU) tedavisi kullanıma girmiştir. HIFU tedavisi, klinik kullanıma girdiği ilk yıllarda yaş ve komorbiditelerinden dolayı cerrahi için uygun olmayan hastalarda kullanılmıştır. Ancak teknolojik gelişmeler ve klinik tecrübelerin artmasıyla günümüzde prostat kanserlerinin primer, kurtarma ve fokal tedavilerinde tercih edilmektedir. Avrupa ülkelerinde lokal hastalığın tedavisinde önerilmesine rağmen (Avrupa üroloji kılavuzunda lokalize düşük dereceli prostat kanserinde öneri derecesi 3, kanıt derecesi C), ABD’de prostat ablasyonu için FDA onayını 2015 yılında alabilmiştir. Bu derlemede prostat kanserinde HIFU yönteminin çalışma prensibi, güncel cihazları, tedavi endikasyonları, etkinliği ve sonuçları tartışılmıştır.

Anahtar Kelimeler:

Prostat kanseri, HIFU, Fokal Tedavi

High intensity focused ultrasound (HIFU) : Importance in the treatment of prostate cancer

Radical prostatectomy and radiotherapy are the recommended standard treatment modalities for the management of prostate cancer in current clinical guidelines. With the discovery of the biological effects of piezoelectric sources on tissues, high-intensity focused ultrasound (HIFU) therapy was introduced as a new treatment modality for prostate cancer in 1980s. In early years, HIFU therapy was applied only for patients, who were not suitable for surgery due to age and comorbidities. However, with technological developments and growing clinical experiences, it is currently preferred for primary, salvage and focal therapy of prostate cancer. Although HIFU is used routinely in clinical practice in European Countries (the suggest degree 3 and the level of evidence C for localized low-grade prostate cancer in European Association of Urology guidelines), FDA approval was provided in 2015 for prostatic tissue ablation in the United States. In this review, we discuss the working principle, latest devices, therapeutic indications, effectiveness and results of HIFU therapy.

Keywords:

Prostate cancer, HIFU, Focal Therapy,

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