الفهرس 
? Physiology and Normal Prostate FunctionOnly 14 pages are availabe for public view
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Abstract
Prostate cancer is a major health issue affecting men. Its incidence is about 15%. The number of men diagnosed with cancer prostate is increasing throughout the whole world.
Seventy percent of the present cases have organ confined prostate cancer at time of diagnosis. So, the diagnosis of prostate cancer depends on triade which are DRE, PSA and TRUS-directed biopsy.
The combination of DRE and serum PSA are the most useful 1st line test for assessing of prostate cancer. The concentration of PSA in serum correlate with pathologic stage and tumor volume and used as positive follow up marker for different lines of management.
There are two established forms of therapy for patient with localized prostate cancer, are: 1) surgery, 2) radiation therapy.
Both therapies have undergone significant technical development during last 10 years.
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 of Gleason score 7 or less.
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.
Irradiation was an alternative for patient where they are not fit for surgery. But both surgery or irradiation have a lot of morbidities.
Recently, a relatively new modality of treatment is used which is brachytherapy, cryotherapy and HIFU.
HIFU destroys cancer prostatic cells by coagulative necrosis without damaging the nearby structure. It achieved through thermal effect and cavity formation.
The indication for HIFU include patient with stage T1-T2 N0M0, not candidate for radical prostatectomy. Also, can be used as a salvage therapy in patient who have local recurrence after external beam radiation or unsuccessful brachytherapy.
Results of HIFU are promising as reported by Blana et al. (2004) who had a case series of 146 patient with mean age 66.9 years and mean follow up 22.5ms with clinical stage T1-T2 N0M0, biopsy-proven localized prostate cancer serum PSA level < 15 ng/ml and Gleason score 7 or less. At follow up they had negative biopsies in 93.4% of patient with PSA nadir < 1ng/ml in 92% of patients.
The results of these studies and others have made HIFU an effective line of management for localized prostate cancer.
Still 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.