**Focal High Intensity Focused Ultrasound for Prostate Cancer**

Fouad Aoun, Marc Zanaty, Alexandre Peltier and Roland van Velthoven

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/60267

#### **1. Introduction**

Conventional treatment options for organ confined prostate cancer range from active surveil‐ lance to whole gland radical therapy. Active surveillance has the distinct advantage of avoiding over treatment and treatment related morbidity but carries the risk of silent progres‐ sion of prostate cancer in up to 35 % of cases [1]. It may also induce no treatment related significant anxiety and uncertainty [2]. Radical therapy has the advantage of improving the overall and cancer specific survival in appropriately selected patients [3-4] but bears significant risk of treatment related functional complications that detrimentally affect quality of life [5-6]. Therefore, counseling patients for appropriate, individual treatment strategy remains chal‐ lenging even for experienced physicians.

Consequently, focal therapy has emerged as an alternative option to standard therapies. The goal of this tissue preserving strategy as defined by the International Task Force on Prostate Cancer and the Focal Lesion Paradigm would be to 'selectively ablate(s) known disease and preserve(s) existing functions, with the overall objective of minimizing lifetime morbidity without compromising life expectancy [7]. A number of focal therapy energies and modalities have commonly been used [8]. Among these therapies, High Intensity Focused Ultrasound (HIFU) emerged as a valid mini invasive therapy for localised prostate cancer, using focused ultrasound to generate areas of intense heat to induce tissue necrosis. This energy delivery system originally used to treat the whole prostate is used nowadays to treat a part of the gland. Many case series have reported encouraging short term functional and oncological results of men with prostate cancer treated primarily in a focal manner [8-19]. Recently, we have published the first mid-term report (median follow up of 38 months) of focal HIFU for a clinically unilateral prostate cancer.

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