الفهرس 
Applied Anatomy of the ProstateOnly 14 pages are availabe for public view
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Abstract
Prostatic cancer is a major health issue affecting men. Its incidence has been increasing being now one of the leading causes of morbidity and mortality for men in the world. It is estimated that, in Western countries, about 30% of all men will develop microscopic prostatic cancer during their lifetime (Timothy; 2003).
The triad-of DRE, serum PSA and TRUS-directed prostatic biopsy is used in the early detection of prostatic cancer with the Combination of DRE and serum PSA being the most useful first line test for assessing the risk of prostatic cancer (Van Der Cruijsen-Koeter et al; 2001).
Fortunately, in the era of PSA, over 90% of patients present with loco regional disease where several treatment options are available (Uchida et al; 2006).
The treatment of localized prostatic cancer was eventually lying between two options, radical therapy and active surveillance (AS) (Ahmed et al; 2007).
Radical prostatectomy is the gold standard treatment for patient with localized prostate cancer mainly with life expectancy more than 10 years, PSA < 20 ng/ml and with Gleason score 7 or less. But not all patients are candidate for this type of surgery, especially if they are older age or associated co-morbidities e.g. cardiovascular disease, morbid obesity, patient refusing surgery or need another line of management. Besides, it has near certainty of either sexual or urinary morbidity.
Active surveillance preserves genitourinary function yet in exchange for the psychological and health care burden of intensive surveillance.
(Theodorescu and Krupski; 2010)
Recently new modalities have been developed to treat localized prostate cancer destroying tumor tissue leaving the normal tissue around (Focal therapy). The available modalities that have been studied to date include cryotherapy, high intensity focused ultrasound (HIFU), laser ablation and photo dynamic therapy (Linder et al; 2010).
HIFU uses high intensity (>5 W/cm2) ultrasound waves which are focused by physical or electronic means on the target lesion in the prostate leading to coagulative necrosis without destroying the surrounding tissue. This is achieved through thermal effect and cavity formation (Zacharakis et al; 2008).
The indication for HIFU include patient with Clinical/pathological stages T1c-T3. Also, it can be used as a salvage therapy in patients who have local recurrence after external beam radiation or unsuccessful brachytherapy. It can be repeated and radical prostatectomy can be performed after HIFU in case of failure (Chinn; 2008).
HIFU has certain limitations including patient movement, heat-sink effect and prostatic calcifications. It also has some contraindications including large prostatic volume (˃ 40 gm), anal diseases interfering with probe insertion and rectal fistula.
Results of HIFU are promising as reported by Ahmed et al (2010) who studied fourteen series which reported outcome data of the use of HIFU for the treatment of localized prostatic cancer, patient numbers ranging from 30 to 402 with mean follow up period ranging from 11 to 76.8 months. Biochemical outcome was reported using mean PSA values and PSA nadir values with the following results (<1, <0.5, <0.2, <0.3, and 0.1 ng/mL in more than 70 %). positive biopsies range at follow up was from 7 to 34%.
(Ahmed et al; 2010)
The results of these studies and others have made HIFU an effective line of management for localized prostatic cancer. Yet further long-term follow-up and randomized controlled trials are required to support and define the exact role of HIFU in management of localized prostate cancer and to accurately define possible morbidity outcome associated with HIFU.