Combination of transurethral and interstitial ultrasound applicators for high-temperature prostate thermal therapy

The purpose of this study was to determine the feasibility of using a transurethral ultrasound applicator in combination with implantable ultrasound applicators for inducing thermal coagulation and necrosis of localized cancer lesions or benign disease within the prostate gland. The potential to treat target zones in the anterior and lateral portions of the prostate with the angularly directive transurethral applicator, while simultaneously treating regions of extracapsular extension and zones in the posterior prostate with the directive implantable applicators in combination with a rectal cooling bolus, is evaluated. Biothermal computer simulations, acoustic characterizations, and in vivo thermal dosimetry experiments with canine prostates were used to evaluate the performance of each applicator type and combinations thereof. Simulations have demonstrated that transurethral applicators with 180-270° acoustic active zones can direct therapeutic heating patterns to the anterior and lateral prostate, implantable needles can isolate heating to the posterior gland while avoiding rectal tissue, and that the combination of applicators can be used to produce conformal heating to the whole gland. Single implantable applicators (1.8mm ODx10mm long, ∼180° active sector, ∼7MHz, direct-coupled type) produced directional thermal lesions within in vivo prostate, with temperatures >50°C extending more than 10mm radially after 10-15min. Combination of interstitial applicators (1-2) and a transurethral applicator (3-2.5mm ODx6 mm long, 180° active sector, 6.8MHz, 6 mm OD delivery catheter) produced conforming temperature distributions (48-85°C) and zones of acute thermal damage within 15min. The preliminary results of this investigation demonstrate that implantable directional ultrasound applicators, in combination with a transurethral ultrasound applicator, have the potential to provide thermal coagulation and necrosis of small or large regions within the prostate gland, while sparing thermally sensitive rectal tissue.