High‐energy Underwater Shock Wave Treatment for Internal Iliac Muscle Metastasis of Prostatic Cancer: A First Clinicla Trial

The first clinical trial of high‐energy shock wave (SW) combined with chemotherapy to treat metastasis of prostate cancer in the internal iliac muscle was conducted. The patient, a 57‐year‐old man, diagnosed as having mucin‐producing, poorly differentiated adenocarcinoma of the prostate invading the bladder wall, had been treated by total cystoprostatectomy. Five months later, metastatic tumors were found in the left axillar subcutaneous tissue and the right internal iliac muscles. For the axillar metastasis we performed radiation and left subclavicular arterial infusion of cisplatin 70 mg, THP‐adriamycin (THP) 50 mg and methotrexate 50 mg. For the right internal muscular metastasis, 10,000 to 20,000 shots of SW and simultaneous intravenous injection of carboplatin 100 mg and THP 10 mg were carried out. Neither of the tumors decreased in size, but on magnetic resonance images, the SW‐treated tumor exhibited a central low‐intensity area. The SW‐treated tumor was resected and central necrosis and a collection of mucin in the central area were observed. Hormone‐resistant prostate cancer is well‐known to be a multidrug‐resistant tumor. It is noteworthy that SW and chemotherapy induced necrosis in such a refractory cancer without any significant side effects.