HIFU and cryoablation--non or minimal touch techniques for the treatment of prostate cancer. Is there a role for contrast enhanced ultrasound?

The incidence of prostate cancer is increasing, and therefore also the need for optimal treatment. Because of the appearance of many different disease stages different treatment modalities are desirable for the treatment of localized prostate cancer. The established therapies, radical prostatectomy and radiation therapy, are associated with a lot of risks, complications and co-morbidity, and not all patients are eligible for these treatments. That is why the need for reliable minimally invasive alternatives has developed. For this paper a literature search was conducted on published studies and review articles to determine the role of HIFU (high intensity focused ultrasound) and cryoablation as minimally invasive treatment modalities for localized prostate cancer. Both therapies are being used as a primary or secondary (salvage) treatment, but can they replace surgery or radiation? And is there a role for contrast enhanced ultrasound (CEUS) of the prostate to improve diagnostics, treatment outcomes and follow-up? To date the outcomes of both therapies are promising but no prospective and comparative randomized studies with a long term follow-up were available for analysis. From this review we can conclude that until those studies are available, HIFU and cryoablation are good alternatives for patients not eligible for prostatectomy or radiation. They should not be used as a first treatment option as long as diagnostics and follow-up have not improved.