**5. Mechanism**

154 Prostate Cancer – Diagnostic and Therapeutic Advances

Fig. 4. On the screen, it is possible to follow the procedure and to change settings, such as ultrasound frequency and shot duration. Thus, a safe and optimal treatment can be performed.

In order to safely perform the treatment, the surgeon is advised to follow some

a. Anti-trombotic prophylaxis with sodic Dalteparin 5.000 I.U. the day before the procedure. Other low molecular weight heparin (LMWH) can be administrated,

b. Antibiotic prophylaxis should be given in order to prevent infection. A quinolone represents a good choice, but other antibiotic can be used, according with local policies. c. Careful intestinal toilet. This is an important key point in infection prevention. Also, it is fundamental to obtain a good view of the whole prostate on ultrasound, which is important in order to treat the target area properly. This will also prevent some side effects of the treatment, such as bladder neck irritation, reduces the risk of rectum

If Marcaine is administrated, it is important to begin the procedure from the left lobe of the prostate, because this lobe is above due to the left decubitus of the patient on the device. In order to make the procedure more bearable and to obtain the best cooperation from the patient, Midazolam 0,03 mg/kg administration during the procedure is recommended.

**4. Management of the patient before and after the procedure** 

fistulisation, and improves the erectile function outcome.

All patients undergo intra-spinal block with Chirocaine®.

Marcaine® can be used instead of Chirocaine.

according with local policies.

recommendations, in accordance with the European and American guidelines:

Conceptually, a piezoelectric transducer generates a high intensity converging ultrasound beam that destroys local tissues through three mechanisms:


These three key-points are discussed below.
