Technical development in high‐intensity focused ultrasound for localized prostate cancer: Intraoperative compression of the prostate

Abstract High‐intensity focused ultrasound (HIFU) has emerged as a widely adopted, minimally invasive treatment for localized prostate cancer (PC). Although originally applied for whole‐gland treatment, recent advancements in imaging and technology have facilitated the adoption of HIFU as a focal therapy modality, targeting clinically significant prostate cancer (CSPC) while preserving surrounding functional structures. Recently, transrectal prostate compression during HIFU has been developed to improve treatment precision by reducing intraoperative prostatic swelling and minimizing target displacement. This method improves the ultrasound propagation path, enhances cavitation, and mitigates the heat‐sink effect by reducing blood flow within the prostate. Clinical outcomes using HIFU with compression in 240 patients demonstrated high biochemical and pathological disease‐free survival rates across low‐, intermediate‐, and high‐risk groups (93.7%/92.2%, 88.5%/91.6%, and 84.8%/86.6%, respectively), with radical treatment‐free survival >94% in all groups. Complication rates were low, with no cases of recto‐urethral fistula reported. The rate of CSPC detection in follow‐up biopsies was significantly lower than in previous studies, suggesting improved local control. These findings support the efficacy and safety of focal HIFU therapy with intraoperative compression as a promising treatment for localized PC.