Description of climate change scenarios.
\r\n\tThe protection of biodiversity is a major target of the European Union Marine Strategy Framework Directive, requiring an assessment of the status of biodiversity on the level of species, habitats, and ecosystems including genetic diversity and the role of biodiversity in food web structure and functioning. The restoration of marine ecosystems can support the productivity and reliability of goods and services that the ocean provides to humankind, to maintain ecosystem integrity and stability. Some of the goods produced by the marine ecosystem services are fish harvests, wild plant and animal resources, water, some of the services provided recreation, tourism, breeding and nursery habitats, water transport, carbon sequestration, erosion control, and habitat provision.
",isbn:"978-1-83968-460-9",printIsbn:"978-1-83968-459-3",pdfIsbn:"978-1-83968-544-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"727e7eb3d4ba529ec5eb4f150e078523",bookSignature:"Dr. Ana M.M. Marta Gonçalves",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10845.jpg",keywords:"Non-indigenous Species, Dynamics, Ecosystem Maturation, Ecological Succession, Water Quality, Recovery, Biodiversity, Environmental Status, Ecosystem Services, Goods Production, Carbohydrates, Carrageenan",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 14th 2022",dateEndSecondStepPublish:"June 22nd 2022",dateEndThirdStepPublish:"August 21st 2022",dateEndFourthStepPublish:"November 9th 2022",dateEndFifthStepPublish:"January 8th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Dr. Ana Marta Gonçalves (h-index 19) holds a Ph.D. in Biology, from the University of Coimbra, Portugal, in collaboration with Ghent University, in 2011. During her research career obtained several grants is highly international competitive calls, including the MARS award for young scientists funded by The Royal Netherlands Institute for Sea Research (NIOZ) and the Foundation for Science and Technology (FCT, Portugal) grants.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"320124",title:"Dr.",name:"Ana M.M.",middleName:"Marta",surname:"Gonçalves",slug:"ana-m.m.-goncalves",fullName:"Ana M.M. Gonçalves",profilePictureURL:"https://mts.intechopen.com/storage/users/320124/images/system/320124.jpg",biography:"Ana Marta Gonçalves obtained a Ph.D. in Biology with a specialization in Ecology from the University of Coimbra, Portugal, in collaboration with Ghent University, Belgium, in 2011. Currently, she is an auxiliary researcher at the Marine and Environmental Sciences Center (MARE), Portugal, where she is also a member of the Directive Board. Since 2016, she has been a member of the Scientific Council of the Institute for Interdisciplinary Research, University of Coimbra (IIIUC). Dr. Gonçalves holds various administrative and management positions in international networks, societies (e.g., Society of Environmental Toxicology and Chemistry, AIL), and associations (e.g., PROAQUA). She is an editorial board member and reviewer for several indexed journals. She has published more than 70 journal articles, 50 book chapters, and 165 communications in international scientific events. She participated as a member and/or coordinator in more than twenty-five national and international projects and is currently the coordinator of four research projects. She has supervised more than ninety-five national and international undergraduate and graduate students. She has experience as a teacher of university courses and in accredited training sessions for teachers. 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And, in addition to its varied orography, it boasts a great diversity of climates and rainy and dry seasons, once or twice a year, depending on the area of interest [1]. The same happens to the influence of climate change in the country, that is, precipitation varies in different ways. Moreover, during Colombia’s Third National Communication on Climate Change before the United Nations Framework Convention on Climate Change (UNFCCC), the Institute of Hydrology, Meteorology and Environmental Studies (IDEAM) said that there would be a reduction in precipitation between 10 and 30% for 27% of the country, specifically in the northern and southern areas of the Colombian territory. Conversely, the same variable is expected to increase in 14% of the territory, in the central and western areas of the country [2].
\nHowever, IDEAM studies cover a very large region of the country, which makes them a poor reference for making local or scale decisions regarding the watershed. Therefore, different studies have been carried out on that scale for different regions of the country, with different climatic and geographical conditions, some of which will be detailed throughout this chapter.
\nThe Intergovernmental Panel on Climate Change (IPCC) has demonstrated—with 95% of certainty—that human beings and their activities are the leading cause of global warming, which has become evident for more than five decades due to the increase in the concentrations of greenhouse gases (GHG). This will produce future changes in extreme weather and climate events throughout the planet. Therefore, the temperature and frequency of extreme events associated with precipitation, both floods and droughts, are very likely to increase progressively [3].
\nIn consequence, a range of future climate scenarios was created in order to establish the potential influence on climate change on the planet in the short, medium, and long term. The SRES scenarios (A1, A2, B1, and B2) [4] used for the fourth assessment report (AR4) depend on a combination of future prospects for economic and technological development, and population growth. And the RCP scenarios or Representative Concentration Pathways (2.6, 4.5, 6.0, and 8.5), used for the fifth assessment report (AR5), are associated with greenhouse gas emissions measured as carbon dioxide [3]. The scenarios mentioned are briefly described in Table 1.
\nScenario | \nDescription | \n
---|---|
SRES A1 | \nIt is a world with rapid economic growth, where the population grows to some extent in the middle of the century and with a rapid spread of efficient new technologies [5] | \n
SRES A2 | \nIt is a self-sufficient world, with continuous population growth and economic development associated with technological changes [5] | \n
SRES B1 | \nIt is a world with a rapid change in economic structures, where the population grows to some extent in the middle of the century and with the introduction of efficient resources and technologies [5] | \n
SRES B2 | \nIt is a world with a local economic, social, and environmental emphasis, with sustainable development, progressive population growth, and economic development oriented toward environmental protection [5] | \n
RCP 2.6 | \nAn increase in CO2Eq emissions is expected for the year 2100 until reaching a concentration of 490 ppm, with a peak prior to that year and a subsequent decrease, which would increase temperature from 0.3 to 1.7°C [2] | \n
RCP 4.5 | \nAn increase in CO2Eq emissions is expected for the year 2100 until reaching a concentration of 650 ppm, with a subsequent stabilization, which would increase temperature from 1.1 to 2.6°C. It is equivalent to SRES B1 [2] | \n
RCP 6.0 | \nAn increase in CO2Eq emissions is expected for the year 2100 until reaching a concentration of 850 ppm, with a subsequent stabilization, which would increase temperature from 1.4 to 3.1°C. It is equivalent to SRES B2 [2] | \n
RCP 8.5 | \nAn increase in CO2Eq emissions is expected for the year 2100 until reaching a concentration of 1370 ppm, with subsequent growth, which would increase temperature from 2.6 to 4.8°C [2] | \n
Description of climate change scenarios.
The indicated table establishes the relationship between the SRES and RCP scenarios with a possible equivalence between them, which can be used as a reference to observe the possible future changes in each of the studies mentioned in this document. Given its broad temporal spectrum, Table 2 shows the different scenarios over different periods of time.
\nModels | \nScenarios | \nPeriod | \nLocation | \nStudy | \n
---|---|---|---|---|
HadGem2-ES, GDFL-CM3 | \nRCP 4.5 and RCP 8.5 | \n2050-2070 | \nUribia, La Guajira | \n[6] | \n
CCSRNIES-A21, CSIROMK2B-A21, CGCM2-A21, CGCM2-A22, CGCM2-A23, HadCM3-A21, HadCM3-A22, HadCM3-A23, HadCM3-A2-SDSM. | \nSRES A2 and B2 | \n2010-2100 | \nSinú-Caribe Basin | \n[7, 8, 9, 10] | \n
BCCCM1-1, CCSM4, GISS-E2-R, HadGEM2-AO, HadGEM2-ES, IPSL-CM5A-LR, MIROC-ESM-CHEM, MIROC-ESM, MIROC5, MRI-CGCM3, NorESM1-M. | \nRCP 2.6, 4.5, 6.0 and 8.5 | \n2050-2070 | \nNilo, Cundinamarca | \n[11, 12] | \n
IPSL-CM5A-LR, IPSL-CM5A-MR, MIROC 5 | \nRCP 4.5 and RCP 8.5 | \n2020-2050 | \nCoello River Basin, Tolima | \n[13] | \n
Models and scenarios according to the reviewed study.
The studies are located in different areas of the country, with different characteristics. The map illustrated in Figure 1 shows their exact location within Colombia.
\nLocations of the studies in the Colombian territory.
This section introduces the studies carried out in different areas of the country, using different methodologies, which are explained in depth in each of the investigations. Additionally, it sets out the possible effects of climate change on the water resources in each location.
\nThis study was carried out in Uribia, located in La Guajira, which corresponds to a desert area according to the Lang’s Index (LI) and with little or no surplus water according to the Thornthwaite climate classification. It is an approximation of what may happen to the abovementioned classifications under climate change scenarios.
\nAs shown in Table 2, this study considered two models and two scenarios. The HadGem2-ES model was the optimistic scenario for the RCP 4.5 scenario in 2050 and the GDFL-CM3 model was the pessimistic scenario for the RCP 8.5 scenario in 2070.
\nA hydrological balance was made both for the baseline (1976–2050) and for the previously mentioned scenarios, based on the meteorological data measured at the Nazareth station and its corresponding future change scenarios due to the influence of climate change. Table 3 shows the annual average values for each variable considered in the water balance.
\nVariable | \nBaseline value | \n
---|---|
Maximum temperature (°C) | \n32.5 | \n
Average temperature (°C) | \n27.3 | \n
Minimum temperature (°C) | \n22.0 | \n
Precipitation (mm) | \n510.2 | \n
Evaporation (mm) | \n2044.5 | \n
Evapotranspiration (mm) | \n1521.1 | \n
Meteorological variables of Nazareth station [6].
The climate change models were reviewed, obtaining an increase of 1.7°C and a 2.4% decrease in precipitation for the optimistic scenario, as well as an increase of 3.7°C and an 11% decrease in precipitation for the pessimistic scenario. This will have a direct effect on the provisional crops, as soil moisture will be reduced.
\nAs an example, Table 4 summarizes the changes in the variables resulting from the water balance and the implications that these changes may have on the water requirements of the corn, bean, and melon crops in the study area.
\nWater layer | \nBaseline | \nGDFL-ESM2G (GD) 4.52050 | \nGDFL-ESM2G (HD) 6.02070 | \nGDFL-ESM2G (HE) 8.52070 | \n||||||
---|---|---|---|---|---|---|---|---|---|---|
Value | \nDifference (mm) | \nChange (%) | \nValue | \nDifference (mm) | \nChange (%) | \nValue | \nDifference (mm) | \nChange (%) | \n||
Def (mm/year) | \n1060.6 | \n1781.5 | \n720.9 | \n1816.1 | \n755.5 | \n1870.8 | \n810.1 | \n|||
Pcp (mm/year) | \n510.2 | \n446.2 | \n−64.0 | \n445.2 | \n−65 | \n446.2 | \n−64.0 | \n|||
ETo (mm/year) | \n1570.8 | \n2227.7 | \n656.9 | \n2261.3 | \n690.5 | \n2317.0 | \n746.1 | \n|||
ETa (mm/year) | \n510.2 | \n446.2 | \n−64 | \n445.2 | \n−65 | \n446.2 | \n−64 | \n|||
Water requirements (mm/year)—Corn | \n257.5 | \n426.9 | \n169.4 | \n426.2 | \n168.7 | \n433.7 | \n176.2 | \n|||
Water requirements (mm/year)—Bean | \n195.9 | \n363.1 | \n167.2 | \n356.6 | \n160.7 | \n370.2 | \n174.3 | \n|||
Water requirements (mm/year)—Melon | \n223.9 | \n403.8 | \n179.9 | \n394.1 | \n170.2 | \n412.5 | \n188.6 | \n
Summary of water balance and requirements for the different scenarios and periods [14].
The bold values highlight the percentage change.
Once the water balance has been carried out with the new weather conditions, it is clear that none of the classifications mentioned at the beginning of this section have changed (Lang and Thornthwaite). However, the conditions of such classification are exacerbated since there is a reduction in the Moisture Index (Im), which may have a negative implication, both ecologically and socially, due to the lower availability and access to drinking water.
\nThis suggests that there is a growing need to investigate this area in order to develop an adequate plan that may include water harvesting projects or efficient crop irrigation systems that take into account the future demands and projected precipitation deficits, to serve as a climate change adaptation strategy.
\nThe influence of climate change in this area of the country was analyzed, evaluating the supply-demand relationship. The activities related to hydroelectric power were taken into account in four investigations that will be briefly described in this section.
\nThis area of the country is deserted due to the anthropic activity in the riverbed of the basin, in addition to the deforestation associated with different activities. It is a region of great importance for the country considering that approximately 66% of the electricity in Colombia is generated in hydroelectric plants [15] and that 3.7% of that value is a direct contribution of the Urra I system, located in the Sinú-Caribe basin. Moreover, it is susceptible to flooding; so the occurrence of extreme precipitation events is important for research related to climate change, considering that due to its influence the events will tend to be more frequent in the future [3].
\nFor the first investigation carried out in 2009 [7], the precipitation and temperature data were initially obtained for two weather stations in the area. Then, some statistical regressions were performed to establish the relationship between the mentioned variables and the flow measured in the basin. Regarding the future projection of precipitation and temperature, some scenarios were generated taking into account the data of climate change models (deltas) and the series observed in the basin stations.
\nWhen reviewing the precipitation projected by each of the models, it was concluded that some projects have an increase and others a decrease, having a possible percentage change between −21 and 14. However, the flow tends to decrease between 2 and 35% regardless of whether precipitation increases or not, given its relationship with other variables.
\nGiven the above, the intention was to establish the sensitivity and vulnerability of the hydroelectric power generation system, creating scenarios based on the supply and demand of the area and the aforementioned climate projections. The scenarios were entered in the “Water Evaluation and Planning System-WEAP 2.1” and it was found that hydropower generation tends to decrease in the future, between 15 and 46%, which can increase the production costs that could be transferred to the users of this service. The above is summarized in Table 5.
\nModel/variable | \nElectricity generation | \nFlow | \n|
---|---|---|---|
Change %\n1\n\n | \nChange %\n2\n\n | \nChange % | \n|
CCSRNIES_A21 | \n−0.7 | \n−16.5 | \n−5.9 | \n
CSIROMK2B_A21 | \n−11.3 | \n−25.4 | \n−2.3 | \n
CGCM2_A21 | \n−0.8 | \n−16.5 | \n−11.8 | \n
CGCM2_A22 | \n−13.7 | \n−27.4 | \n−13.3 | \n
CGCM2_A23 | \n−13.4 | \n−27.1 | \n−11.3 | \n
HadCM3_A21 | \n−35.2 | \n−45.5 | \n−34.9 | \n
HadCM3_A22 | \n−25.9 | \n−37.7 | \n−23.8 | \n
HadCM3_A23 | \n−2.9 | \n−18.3 | \n−14.2 | \n
HadCM3_A2_SDSM | \n0.6 | \n−15.4 | \n−2.3 | \n
Statistic | \n−27.2 | \n−38.8 | \n\n |
Changes in hydroelectric power generation and its related variables [7].
Reference scenario or baseline (1418.9 GWh/year).
Maximum generation capacity (1687.2 GWh/year).
This study indicates that research should be carried out in order to establish the potential vulnerability of systems related to supply and demand in this area under the influence of climate change. Therefore, a subsequent investigation was carried out in which it was considered that the impact on water resources was not only the result of the change in its offer or its quality, but also the pressure on the said offer in which the population and planning processes influence significantly [8].
\nA model was made using WEAP 2.1 software, to simulate hydrological processes in the scenarios concerning anthropogenic changes, land use, demands, and regulations among others. Its methodology is based on obtaining information on the daily consumption and activities in the study area, and their corresponding future increases based on projections. Then, it was contrasted with the reduction in supply due to environmental flow and quality considerations, as well as the possible variation in both temperature and precipitation and its consequent influence on the change in supply. Using WEAP, aspects of the supply-demand relationship were determined, such as unsatisfied demand, demand coverage, supply requirement, supply delivered, demand increase, and resource pressure indices. All scenarios are considered to be consistent with an increase in temperature and a positive or negative change in precipitation, as shown in Appendix 1, with a consequent decrease in the water flow or supply available.
\nAs a result, it was concluded that in all scenarios it is not possible to supply the demand for water resources in all sectors and activities (commercial, industrial, rural, and urban areas), leading to a progressive growth of unsatisfied demand for the year 2039, as shown in Figure 2.
\nTotal unsatisfied demand, Sinú-Caribe basin [
From this research, it is important to highlight the allocation of weights to climate change models based on their contribution to the flow, and their corresponding increase and decrease in temperature and precipitation respectively. Accordingly, a single weighted average scenario was proposed, where the worst possible scenarios are given a greater weight. Therefore, this scenario becomes a tool for planning water conservation strategies, such as the implementation of technologies for the reuse or efficient use of water, as well as the inclusion of vegetation conservation.
\nIt was concluded that the proposed methodology and application of the WEAP tool allow to have a broader view of the resource in a region, allowing a better management of the water resource, with the possibility of planning strategies properly and taking into account adverse effects. This establishes the need to carry out a regionalization of climate change in order to develop tools that allow a detailed observation of its impact at local level. Finally, the inclusion of hydrological variables allows planning based on the water supply, reducing uncertainty in some way.
\nHaving reviewed the supply-demand relationship in this area for different activities and considering the importance of hydroelectric power generation for the country, the need to propose a vulnerability index for this activity was established [9]. Based on the observed and projected data from the previous investigations, both for precipitation and temperature and for flow, as well as on the supply and demand data of the water resource, the WEAP tool was used again to perform a water balance that includes the data mentioned and the operating policies, technical problems, bathymetries, and evaporation in the basin.
\nGiven the above, there is a direct relationship between the flow and the volume of the basin with changes in precipitation and temperature. Therefore, the vulnerability index will depend directly on these two variables, its lowest value being the result of a 10% increase in precipitation and a 0.5°C increase in temperature and the highest value the result of a 10% decrease in precipitation and a 3°C increase in temperature.
\nGiven the cost overruns in energy production, research similar to the previous one supposes the possibility for decision-makers to establish the vulnerability of their systems to climate change, as well as to implement projects to adapt to and mitigate the effects.
\nFinally, it was intended to establish if the availability of water can act as an optimization factor in the generation of hydroelectric power [10]; so, an investigation focused on this topic was carried out. To do so, using both current and future supply and demand values, an adapted scenario was established in which demand decreases by 20% due to the efficient use of water. This makes the critical point at which demand equals supply more distant, having a difference of 5 years on average.
\nAs for hydroelectric generation, some system optimization scenarios were established, including pumping from a downstream point of the basin to an upstream point, which regulates the basin and can be used to mitigate events of flood that, as mentioned, are very likely to occur. The optimization scenarios are contingent on pumping with different start dates and the amount of water extracted. It was established that pumping must begin before the critical point established for each demand scenario to avoid regional conflicts over the use of water.
\nHowever, from this latest investigation it was concluded that the critical point with measures such as pumping only takes a little longer to occur. Therefore, it is crucial to make changes in demand such as establishing appropriate water management and regulation strategies, optimizing water delivery infrastructure, and establishing priorities. This study and the previous ones encourage decision-makers to carry out adaptation projects that take into account all the issues addressed in this section and the changes in the meteorological variables indicated in Appendix 1.
\nThe municipality of Nilo, located in the department of Cundinamarca, is an important region for the production of Cocoa in Colombia. This study seeks to evaluate the water requirements for growing this product in current and future scenarios with climate changes [11].
\nFor this purpose, a baseline was initially established in the period 1975–2005. Then, using variables such as precipitation, temperature, evapotranspiration, among others, a water balance was performed to recognize and characterize the study area, establishing adequate water availability, according to the water resource indices in Table 6. This procedure was repeated again considering the change in the projected meteorological variables for the years 2050 and 2070.
\nIndex | \nDescription | \nValue | \n
---|---|---|
LI | \nThe Lang’s index describes the humidity conditions in the area as the ratio between average annual precipitation and average annual temperature [16] | \nVH: Very humid H: Humid MH: Moderately humid ML: Semiarid L: Arid VL: Desert | \n
HAI | \nThe Hydric availability index allows to identify surpluses or deficiencies of water in specific areas or periods. It is a function of the relationship between the sum of the actual evapotranspiration and a quarter of the surpluses with the potential evapotranspiration [17] | \nVH: Very humid H: Humid MH: Moderately humid M: Optimal ML: Semiarid L: Arid VL: Desert | \n
Description and assessment of the calculated indices.
Additionally, the water requirements of the crop were established using CropWat software, climatic variables of the baseline and future scenarios, as well as some parameters related to soil, which were established based on fieldwork performed in the study area.
\nConsequently, crops were delimited due to water deficiency in soil, as a result of an increase in temperature (T) and a decrease in precipitation (PCP). The aforementioned will involve drought stress, a possible increase in pests, and a drastic reduction in crop yield. In addition, there will be a possible increase in the water deficit (Def) in both the pessimistic and optimistic scenarios, changing the Hydric Availability Index (HAI) in the area from optimal to semiarid, as shown in Table 7. According to the values in Table 7, in terms of the water requirements of the reference crop, a value of 359 mm for the baseline and a consequent increase up to 535 mm were established as a result of climate change.
\nClimate variable/scenario | \nTmin (°C) | \nTmax (°C) | \nTavg (°C) | \nPCP (mm) | \nDef (mm) | \nLI | \nHAI | \n
---|---|---|---|---|---|---|---|
Current | \n21.4 | \n23.4 | \n22.4 | \n1292.0 | \n124.5 | \nM-L | \nM | \n
\n\n | \n\n\n | \n\n\n | \n\n\n | \n\n\n | \n|||
Pessimistic 2050 | \n2.0 | \n2.1 | \n2.1 | \n−39.8 | \n396.4 | \nL | \nL | \n
Optimistic 2050 | \n1.3 | \n2.3 | \n1.8 | \n3.2 | \n31.1 | \nM-L | \nM | \n
Average 2050 | \n1.6 | \n2.1 | \n1.8 | \n−15.8 | \n152.8 | \nL | \nM-L | \n
Pessimistic 2070 | \n2.5 | \n3.5 | \n3.0 | \n−36.5 | \n382.8 | \nL | \nL | \n
Optimistic 2070 | \n2.5 | \n3.7 | \n3.1 | \n14.3 | \n13.9 | \nM-L | \nM | \n
Average 2070 | \n2.1 | \n2.6 | \n2.3 | \n−14.0 | \n150.1 | \nL | \nM-L | \n
Summary of the variation of climatic variables and associated indices [11].
This study opens up the possibility of planning the use of the land, depending on the water requirements of both current and future crops, in order to make sustainable use of the water resource and can serve as a reference for new studies on this subject. This investigation measured the arithmetic average of the results obtained from the different models and scenarios. However, it does not allow observing the effect of each model, which may differ from each other, either in the magnitude of the change in temperature or in the increase or decrease in precipitation.
\nTherefore, the scenarios were grouped into four clusters or groups of similar results, in which the centroid value of each of the variables was obtained, as shown in Table 8. It was decided to assemble a scenario by assigning weight factors to each cluster, in order to generate a unique scenario with the most adverse effects. Since the municipality of Nilo is mainly engaged in agriculture, it was concluded that the most negative effect in this area is the reduction of precipitation and the increase in temperature. Therefore, the clusters in which this occurs will have a greater value at the time of assigning the weight factor (WF) for each of variable [12].
\nVariable/cluster | \n1 | \n2 | \n3 | \n4 | \n
---|---|---|---|---|
Members | \n22 | \n7 | \n7 | \n8 | \n
Percentage | \n50 | \n15.91 | \n15.91 | \n18.18 | \n
Tmin (°C) | \n23.08 | \n23.4 | \n23.39 | \n|
Tmax (°C) | \n33.89 | \n34.06 | \n34.1 | \n|
Tavg (°C) | \n28.49 | \n28.74 | \n28.73 | \n|
PCP (mm) | \n1101.25 | \n1149.27 | \n1314.08 | \n|
Def (mm) | \n294.52 | \n287.76 | \n525.86 | \n191.01 | \n
LI | \nL | \nL | \nL | \nM-L | \n
HAI | \nM-L | \nM-L | \nM-L | \nM-L | \n
0.26 | \n0.68 | \n0.38 | \n||
0.36 | \n1.35 | \n1.17 | \n||
0.34 | \n1.39 | \n1.23 | \n||
0.34 | \n1.38 | \n1.22 | \n
Summary of climatic variables, their associated indices and weights for each cluster [12].
The bold values highlight the greater temperature values on the cluster 2 and so the greatest weighting factor for this variables correspond to the scenarios which are part of that cluster. While the minor precipitation value is in the cluster 3, giving it a greater weighting factor to this variable in the scenarios belonging to this cluster.
Accordingly, a unique scenario (WA) for precipitation and average, minimum and maximum temperatures were established based on the previously assigned weights. This scenario differs from the arithmetic average (AA) of all the scenarios calculated; they were compared with the established baseline (BL), as shown in Figure 3.
\nMonthly behavior of (a) precipitation (b) average temperature [
Establishing a unique scenario as indicated in this investigation allows decision-makers to establish adaptation measures for that single scenario, focusing efforts on preventing or mitigating the most adverse effects for the area of interest, which is of vital importance for the proper management of water resources in an unfavorable future.
\nThe Coello River basin is located in the department of Tolima. It covers a large percentage of its territory and is of great importance for the region since it supplies the municipalities settled there, as well as their economic activities, mainly agricultural. Likewise, it supplies one of the most important irrigation districts in the region due to its large rice and cotton production.
\nAn investigation was conducted in this basin, focused on assessing the implications of climate change on the supply, demand, and indicators of water resource status, namely, indices of aridity, water use, vulnerability to water shortage, and water retention. Its methodology was based on the development of a hydrological model using the Soil and Water Assessment Tool (SWAT), both for the baseline (1976–2005) and for the future period (2020–2050), in which daily precipitation and monthly temperature were entered as input variables.
\nIn the case of temperature, the Delta Method was used as a methodology for the reduction of the geographic scale of the General Circulation Models (GCM) implemented, which consists in establishing the variation of the temperature per month taking as reference the historical data of the GCMs mentioned in Table 2. In the case of precipitation, since a daily resolution was required, it was decided to combine the Delta Method for the monthly scale reduction with the Maximum Entropy Method for the disaggregation of said value on a daily basis, depending on the observed behavior of said variable in each station studied [13].
\nAs a result, a potential increase in annual precipitation was determined as shown in Figure 4. However, there was a sharp decrease in its value at daily resolution as illustrated in Figure 5, which suggests a possible increase in extreme events since large amounts of precipitation are concentrated on specific day(s).
\nMonthly behavior of precipitation. (a) RCP 4.5 (b) RCP 8.5 [
Daily behavior of precipitation. (a) RCP 4.5 (b) RCP 8.5 [
In the case of the maximum temperature, its value increased progressively as illustrated in Figure 6.
\nAnnual behavior of temperature. (a) RCP 4.5 (b) RCP 8.5 [
Once the input variables for the hydrological model have been established, the flow values were obtained throughout the basin, thus establishing the water supply in each of the microbasins. Subsequently, the flows were characterized using flow duration curves, which, compared with the observed value, indicate an increase in the probability of extreme events and a decrease in the average flow that flows through the channel most of the time (Figure 7).
\nFlow duration curve for all the models and RCPs selected, year 2050 [
In the case of demand, having a projection of the meteorological variables and the crop areas, as well as the type of product grown, the water demand was established in terms of the irrigation requirement of said crops using the CropWat tool, as shown in Table 9.
\nDemand/crop | \nPane cane | \nBanana | \nPlantain | \nArracacha | \nRice | \n
---|---|---|---|---|---|
Current | \n13.5 | \n10.6 | \n5.4 | \n2.0 | \n296.3 | \n
IPSL_LR45 | \n20.8 | \n12.4 | \n6.4 | \n1.8 | \n393.1 | \n
IPSL_MR45 | \n16.3 | \n14.2 | \n7.3 | \n2.2 | \n367.5 | \n
MIROC5_45 | \n20.4 | \n10.3 | \n5.3 | \n1.7 | \n314.4 | \n
IPSL_LR85 | \n19.1 | \n19.5 | \n10.0 | \n1.7 | \n390.8 | \n
IPSL_MR85 | \n21.2 | \n14.1 | \n7.2 | \n2.2 | \n362.9 | \n
MIROC5_85 | \n13.1 | \n10.2 | \n5.2 | \n1.9 | \n322.2 | \n
Current | \n1.2 | \n1.1 | \n0.7 | \n36.7 | \n183.5 | \n
IPSL_LR45 | \n1.6 | \n1.3 | \n0.98 | \n50.7 | \n245.5 | \n
IPSL_MR45 | \n1.7 | \n1.4 | \n0.96 | \n45.6 | \n234.4 | \n
MIROC5_45 | \n1.7 | \n1.3 | \n0.89 | \n42.7 | \n210.4 | \n
IPSL_LR85 | \n1.5 | \n1.3 | \n0.94 | \n49.8 | \n243.6 | \n
IPSL_MR85 | \n1.6 | \n1.4 | \n0.97 | \n44 | \n227.3 | \n
MIROC5_85 | \n1.7 | \n1.3 | \n0.9 | \n43.4 | \n211.4 | \n
Current | \n2.6 | \n0.042 | \n0.014 | \n0.33 | \n12.3 | \n
IPSL_LR45 | \n3.6 | \n0.064 | \n0.018 | \n0.53 | \n16.3 | \n
IPSL_MR45 | \n3.2 | \n0.054 | \n0.018 | \n0.47 | \n14.7 | \n
MIROC5_45 | \n3.0 | \n0.042 | \n0.018 | \n0.38 | \n12.2 | \n
IPSL_LR85 | \n3.5 | \n0.063 | \n0.018 | \n0.51 | \n16.1 | \n
IPSL_MR85 | \n3.1 | \n0.055 | \n0.017 | \n0.47 | \n14.8 | \n
MIROC5_85 | \n3.09 | \n0.046 | \n0.018 | \n0.39 | \n13.1 | \n
Irrigation requirement for the crops in the study area [13].
Furthermore, growth projections were defined for both population and other economic activities such as livestock and industry. In this way, the supply that each of them will require in the future was established, noting that no demand for another activity is comparable with that established for the agricultural sector as shown in Table 10.
\nScenario | \nAgricultural sector demand (m3/s) | \nDomestic sector demand (m3/s) | \nIndustrial sector demand (m3/s) | \nTotal demand (m3/s) | \n
---|---|---|---|---|
Current | \n17.73 | \n0.888 | \n0.310 | \n19 | \n
IPSL_CM5A LR RCP 4.5 | \n27.55 | \n1.579 | \n1.790 | \n31 | \n
IPSL_CM5A MR RCP 4.5 | \n26.12 | \n1.579 | \n1.790 | \n30 | \n
MIROC5 RCP 4.5 | \n23.42 | \n1.579 | \n1.790 | \n27 | \n
IPSL_CM5A LR RCP 8.5 | \n27.67 | \n1.579 | \n1.790 | \n31 | \n
IPSL_CM5A MR RCP 8.5 | \n25.84 | \n1.579 | \n1.790 | \n29 | \n
MIROC5 RCP 8.5 | \n23.52 | \n1.579 | \n1.790 | \n27 | \n
Water demand in the scenarios selected. Adapted from [13].
Finally, the water resource status indices were established, which are a function of both the previously calculated supply and demand. This evidenced a strong increase in the Aridity Index (AI) and Water Use Index (WUI), as well as a scenario of improvement with respect to the Index of Vulnerability to Water Shortages (IVWS), Water Retention Index (WRI), and/or the same indices calculated for the baseline. Table 11 shows a brief explanation of these indices.
\nIndex | \nDescription | \nValue | \n
---|---|---|
AI | \nIt describes the degree of surplus or deficiency of precipitation to sustain ecosystems based on potential and actual evapotranspiration, qualifying it from water deficit to water surplus [1] | \nVH: High surplus H: Surplus MH: Moderate to surplus M: Moderate ML: Moderate to deficient L: Deficit VL: Highly deficient | \n
WRI | \nIt establishes the ability to retain and regulate humidity in the basin, according to a relationship between the values extracted from the flow duration curve [13] | \nVH: Very high H: High M: Medium L: Low VL: Very low | \n
WUI | \nIt describes the pressure of the demand with respect to the supply [13] | \nVH: Very high H: High M: Medium L: Low VL: Very low | \n
IVWS | \nIt describes the vulnerability of the water system to the shortage of the resource for different users [1] | \nVH: Very high H: High M: Medium L: Low VL: Very low | \n
Description and assessment of the calculated indices.
Based on the average values of each index, Table 12 shows the total values of the basin.
\nScenario | \nIA | \nWRI | \nWUI | \nIVWS | \n
---|---|---|---|---|
Baseline | \nM | \nH | \nH | \nM | \n
IPSL-CM5A-LR – RCP 4.5 | \nM | \nM | \nVH | \nH | \n
IPSL-CM5A-MR – RCP 4.5 | \nM | \nM | \nVH | \nH | \n
MIROC 5 – RCP 4.5 | \nM-H | \nM | \nVH | \nH | \n
IPSL-CM5A-LR – RCP 8.5 | \nM | \nH | \nVH | \nM | \n
IPSL-CM5A-MR – RCP 8.5 | \nM | \nM | \nVH | \nH | \n
MIROC 5 – RCP 8.5 | \nM-H | \nH | \nVH | \nM | \n
Average values of each index for the baseline and each projected scenario. Adapted from [13].
It is worth noting that these indices were calculated with a spatial distribution defined by the microbasins of the hydrological model, for each month of the year, so the research includes maps of each index such as those illustrated in Figure 8.
\nSpatialized values for the IPSL-CM5A-MR RCP 8.5 model for (a) water use and (b) vulnerability to water shortages [
However, despite obtaining an optimistic future scenario unlike other regions of the country, this should be used with caution given the uncertainty that it entails; for example, there was an increase in the amount of monthly precipitation but a decrease in the daily average, indicating an increase in the intensities concentrated on specific days. The foregoing has a direct influence on the water retention index, which may give an unsuccessful perspective on the optimism of the scenario.
\nFinally, studies such as the one mentioned above may be of great interest to decision-makers, since they broaden their spectrum of possible future scenarios, in order to adopt measures that mitigate the possible impacts of climate change.
\nIt was concluded that the effects of climate change throughout the country are very varied in contrast to its current state. These changes are summarized in Appendix 1, where there is mostly a decrease in the amount of precipitation in the future under climate change scenarios, with the exception of the Coello River basin area where there is an increment. It should be noted that in the latter case this increase occurs at monthly resolution and that on a daily scale there is a decrease in this variable with possible concentrations on specific days. This suggests a possible increase in precipitation intensity and consequently a possible increase in extreme events.
\nIn the case of temperature, all studies agree that there will be an increase from 0.5 °C in the period 2011–2040 to almost 4 °C in the period 2071–2100 in different scenarios and areas as detailed in Appendix 1. The foregoing has a direct implication in related activities as explained in this chapter. A possible decrease in hydroelectric generation is expected given both the increase in temperature and the variation in precipitation. In addition, in the case of agricultural activities, the increase in temperature has a direct effect on evapotranspiration and consequently on the irrigation requirements of the crop, which will also depend on changes in precipitation.
\nIn turn, the change in the variables, added to other anthropic activities expressed in terms of water demand, can exert significant pressure on the water resource. This could represent an increase in the vulnerability to shortages and unsatisfied demands, generating a risk associated with food security and water use for the population in the country. This, in addition to the potential risks associated with the increase in extreme events, that is, floods or droughts, has a direct impact on the inhabitants and their economic activities.
\nThe latter stresses the need to conduct studies with a finer resolution both geographically and temporally in order to determine the potential impacts of climate change more accurately, serving as a tool for decision-makers. Using these tools, it is possible to establish strategies for the proper management of water resources, management plans that take into account future scenarios, as well as the importance of water availability to avoid regional conflicts.
\nSite | \nBaseline | \nScenarios | \n2011–2040 | \n2041–2070 | \n2071–2100 | \n\n | ||||
---|---|---|---|---|---|---|---|---|---|---|
\n\n | \n\n\n | \n\n\n | \n\n\n | \n\n\n | \n\n\n | \n\n\n | \n\n\n | \n\n | ||
Nilo | \n26.5 | \n1292 | \nArithmetic average | \n\n | \n | 1.8 | \n−16 | \n2.3 | \n−14 | \n[11] | \n
Weighted average | \n\n | \n | \n | \n | 2.7 | \n−25.3 | \n[12] | \n|||
Uribia | \n27.3 | \n510.2 | \nHadGem – RCP 4.5 | \n\n | \n | 1.7 | \n−2.4 | \n\n | \n | [6] | \n
GDFL–CM3 - RCP 8.5 | \n\n | \n | \n | \n | 3.7 | \n−11 | \n||||
Sinú | \n28.2 | \n2212 | \nHad-CM3 - A2 | \n1.3 | \n7.5 | \n2.0 | \n19.7 | \n2.5 | \n30.4 | \n[7] | \n
Had-CM3- B2 | \n0.9 | \n10.9 | \n1.3 | \n17.4 | \n1.7 | \n25.9 | \n||||
CCSRNIES_A21 | \n0.5 | \n−5.9 | \n\n | \n | \n | \n | ||||
CSIROMK2B_A21 | \n0.7 | \n−2.3 | \n\n | \n | \n | \n | ||||
CGCM2_A21 | \n0.7 | \n−11.8 | \n\n | \n | \n | \n | ||||
CGCM2_A22 | \n0.9 | \n−13.3 | \n\n | \n | \n | \n | ||||
CGCM2_A23 | \n0.8 | \n−11.3 | \n\n | \n | \n | \n | ||||
HadCM3_A21 | \n1.9 | \n−34.9 | \n\n | \n | \n | \n | ||||
HadCM3_A22 | \n1.6 | \n−23.8 | \n\n | \n | \n | \n | ||||
HadCM3_A23 | \n1.4 | \n−14.2 | \n\n | \n | \n | \n | ||||
HadCM3_A2_SDSM | \n0.5 | \n−2.3 | \n\n | \n | \n | \n | ||||
Coello | \n18.8 | \n1520 | \nIPSL-CM5A-LR – RCP 4.5 | \n\n | \n | 1.1 | \n−4.3 | \n\n | \n | [13] | \n
IPSL-CM5A-MR – RCP 4.5 | \n\n | \n | 1.2 | \n5.6 | \n\n | \n | ||||
MIROC 5 – RCP 4.5 | \n\n | \n | 1.1 | \n11.9 | \n\n | \n | ||||
IPSL-CM5A-LR – RCP 8.5 | \n\n | \n | 1.4 | \n2.5 | \n\n | \n | ||||
IPSL-CM5A-MR – RCP 8.5 | \n\n | \n | 1.4 | \n23.8 | \n\n | \n | ||||
MIROC 5 – RCP 8.5 | \n\n | \n | 1.1 | \n10.4 | \n\n | \n |
Changes in temperature and precipitation for the different studies in this chapter.
\nClinical benign prostate hyperplasia is an aging disease, with a high prevalence after 40 years of age, from 8 to 60% at 90 years. The interventional treatments include open adenoma removal, transurethral resection of the prostate, HOLMIUM, and THULIUMenucleation, laser vaporization, steam ablation, microwavethermotherapy, etcetera. Prostate cancer has a high incidence in men over 60 years and is considered the second cause of death. Early detection assisted by PSA (prostate-specific antigen), MR imaging, and in some centers PSMA PET SCAN, and targeted biopsies, let us offer less invasive techniques, compared with radical prostatectomy or external beam radiation, with a decrease of morbidity, achieving what has been called “TRIFECTA”: disease control, urinary continence and erectile function.
High intensity focused ultrasound, a relatively new technique, uses a sound beam directed to a specific spot inside the prostate parenchyma, causing thermal ablation with customized planning, including whole gland, the benign enlargement of localized lesions, defined as focal therapies. More than 50,000 treatments have been performed worldwide, with growing improvement in the outcomes, mainly caused by a good selection of cases and technical improvements of imaging and emission of sound beams. By 2010, Sonablate and Ablatherm devices were used widely in some countries of Latin America (Mexico, Brazil, Ecuador, and Argentina), Europe and Japan, in 2015 FDA cleared the usage of HIFU with both machines. Some countries still consider HIFU as experimental therapy [1, 2].
Sound has been for several centuries a subject of interest for the different branches of science, been the development of its understanding as a physical phenomenon and its use in the different fields of science and technology the main topics. The medical sciences have not been the exception in this search. Ultrasound, a technology derived from sound, has had a significant boom in medicine due to its implementation as a diagnostic or therapeutic instrument. It has been widely disseminated as a diagnostic instrument due to its various advantages ranging from cost–benefit to high sensitivity and specificity for diagnosing pathologies [3]. As a therapeutic option, ultrasound has been used for the development of technologies such as extracorporeal lithotripsy, HIFU, sonophoresis, sonodynamic therapy, sonothrombolysis or histotripsy, among others, which base their efficacy on the induction of sonic bio-effects, both thermal and non-thermal (cavitation, radiation, etcetera) to induce tissue changes [4, 5].
The difference between ultrasound as a diagnostic or therapeutic technology is based on inducing a certain amount of bioeffect at the tissue level [4]. Ultrasound as a diagnostic tool seeks to induce the least possible bioeffect [4, 6]. In contrast, ultrasound as a therapy seeks certain technologies to achieve tissue ablation through inducing thermal or non-thermal bioeffects, such as the HIFU [4, 5, 6].
HIFU had its first antecedents in 1942 when the first destruction of tissue was recorded through an extracorporeal ultrasound energy source [5]; later, in the 1990s, its technology was refined by integrating real-time imaging methods for monitoring the procedure [5]. The use of real-time imaging has improved the efficacy of this treatment, reducing morbidity and mortality at making the treatment more accurate [5, 7]. Its clinical implementation increased significantly after the clinical case report of a patient treating a malignant bone neoplasm in Chongqing, China, in 1997 [5]. During the following 15 years, the use of HIFU clinically reported more than 30,000 cases of kidney, pancreas, bone, liver, or uterine fibroids, showing its great utility as a minimally invasive technology [5, 8]. Currently, HIFU technology can be divided according to the radiological technique used to guide the procedure (Magnetic Resonance or Diagnostic Ultrasound) or according to the system used to deliver the energetic (transrectal for the treatment of prostate pathologies, interstitial for the treatment of biliary or esophageal tumors, extracorporeal for the treatment of organs accessible to sound through the skin) [5, 7, 9].
For this chapter, and to delve into HIFU therapy and its biophysical effects, it is necessary to understand some basic concepts of the physics of sound.
Once a pulse is generated, the energy will oscillate the particles closest to the origin of the pulse, and these particles will, in turn, oscillate with those immediately adjacent so that this energy will be transmitted from proximal to distal. Each pulse generates positive pressure and negative pressure in one wave, together are wave cycles [5, 7].
The HIFU as a therapeutic ultrasound system generates an intensity of approximately 1000–20,000 W/cm2, generating an elevation of between 60 and 100° C in 1 second in that unit area while using a frequency around 0.8−5 MegaHertz (each MegaHertz = 106 Hertz) (Figure 1) [4, 6, 8].
Sound properties. Schematic representation of sound properties. Created with
Multiple bio-effects have been described (thermal and non-thermal) related to the exposure of a sound field by a tissue. Different authors have classified these as thermal and non-thermal bio-effects [4, 5]. For its part, the HIFU system predominantly generates thermal bio-effects; however, these are not pure, since the presence of other non-thermal bio-effects such as cavitation has been described in the same tissue [4].
The main bio-effect caused by HIFU has been compared to the use of a magnifying glass to focus the sun’s rays on a point [6] because it generates a frequency of 0.8−5 MegaHertz with a wavelength of 2−0.3 mm, this is translated into a small area subjected to great ultrasonic power [6, 7]. As we previously mentioned, when this power crosses a specific point can be translated into intensity, being in the case of HIFU between 1000−20,000 watts/cm2 [5, 6]. It is considered that it is necessary to raise the temperature of the tissue to 56–60° C or more for about a second to produce an irreversible cytotoxic lesion with protein denaturation and heat-induced coagulative necrosis; using this concept of the irreversible lesion induced by heat, the result can be inferred from raising the temperature to around 60–100° C at a focal point as occurs with HIFU therapy (Figure 2) [4, 5, 6].
Temperature changes are produced at the focal point, and near the transducer. (Courtesy of HIFUMx).
In different in vivo studies, it has been observed that the main effect caused by HIFU as a thermal injury is the induction of coagulative necrosis through protein denaturation and induction of apoptosis via nuclear lysis by endonucleases [5]. Specific characteristics have been described that differentiate this coagulative necrosis derived from thermal injury from coagulative necrosis of ischemic origin. The difference is mainly due to the predominance in the interaction of giant cells with chronic inflammation, unlike the tissue regeneration process via granulation tissue seen in coagulative necrosis due to ischemia [5].
Associated with coagulative necrosis, the ability of HIFU to injure small-caliber vessels (<2 mm) has been described as an endothelial lesion, and thrombosis of these vessels with these characteristics has been found in various studies. However, the ability of larger vessels to dissipate temperature has been described, thus suffering minor injury (heat sink) (Figure 3) [5].
Thermal ablation. Schematic representation of thermal ablation mechanism and specificity.
The second most crucial mechanism described during the HIFU treatment is the non-thermal bio-effect of a mechanical type induced through cavitation [5, 9]. Cavitation can be defined as gas or vapor cavities forming within a liquid medium and their subsequent dynamics in this medium [5]. Cavitation formation can occur under different conditions (hydrodynamic, thermal, or acoustic energy changes); its importance lies in the possibility of generating a lesion adjacent to the formation of these cavities through micro-boiling, increased temperature, and shear stress [4, 5]. Cavitation, unlike temperature-induced injury, is more unstable in nature and less predictable (Figure 4) [5].
Mechanical destruction. Schematic representation of mechanical destruction mechanism and specificity.
Two types of cavitation have been described by their nature, stable (non-inertial) cavitation and transient (inertial) cavitation [4]. Transient cavitation involves a significant change in bubble size in a period of few acoustic cycles [4], resulting in a more aggressive collapse [4, 5]. In contrast, stable cavitation maintains a more stable range in terms of growth of its diameter without significant growth and remains stable during many acoustic cycles [4, 5].
The appearance of these cavities depends on the different properties of both the source of acoustic energy and the medium where this energy will be exerted. Generally, it is known that to a greater extent, the temperature and pressure exerted on the medium are essential determinants for the formation of cavities. The temperature is inversely proportional to the cavitation threshold (the possibility of a said event happening) [4, 5].
Its importance lies in the possibility of causing more significant tissue damage, currently a field of study for the development of therapies such as histotripsy, which base their efficacy on this principle (Figure 5).
Massive controlled cavitation formed in the posterior aspect of the prostate adenoma (Urovallarta Urology Center).
The first HIFU technology used for the treatment of prostate cancer to become available was Ablatherm® (Edap-Technomed, Lyon, France), with initial clinical results published in 1996 [10].
The Ablatherm system uses separate crystals to produce an image (7.5 MHz) and to deliver treatment (3 MHz), and since 2005, the two types of transducers have been integrated into the same probe, which has a focal point of 45 mm from the crystal. The 3 MHz treatment crystal creates an ablation zone with a volume that can range from 29 mm3 to 36 mm3. The Ablatherm has 3 different types of treatment algorithms, each designed for a specific application: HIFU as primary treatment, HIFU as secondary treatment after failed Radiation Therapy, and HIFU re-treatment [11].
The Ablatherm has a mechanism to detect patient movement based on an internal automatic A-mode ultrasound detection system, which together with the external ultrasound used during the treatment planning phase, measures the distance from the rectal wall, and ensures that the patient has not moved [12].
Treatment with the Ablatherm is performed with the patient in a lateral decubitus position, on their right side. This is done as a precautionary measure, since if there were any bubbles in the liquid around the transducer used for the treatment, these would rise out of the treatment field, with the patient on their side, and the bubbles would not remain between the transducer crystal and the prostate [13].
Focal One® (Edap-Technomed, Lyon, France) is the first HIFU device, specifically designed to perform focal therapy and was introduced for the focal treatment of prostate cancer. With this device, the procedure is performed on a conventional surgical table with the patient in a lateral position to avoid air bubbles in between the crystal and the rectal wall.
The transducer that uses focal one is a dynamic focus transducer, made with 16 isocentric rings, each ring is moved by a dedicated electronic system, composed of 16 lines, this allows the user to move the focal point of the transducer to a maximum of 8 different points that are between 32 and 67 mm from the transducer. The dynamic approach treatment involves unitary HIFU lesions, stacked in the prostate, within the axis of the ultrasound. Each lesion measures approximately 5 mm and by stacking 2 to 8 lesions it is possible to extend the necrotic area by 5 to 40 mm [14].
Focus Surgery (Indianapolis, IN, USA) introduced the Sonablate500® system and preliminary results of its use for the treatment of prostate cancer were published in 2002 [15]. The Sonablate uses a single crystal to obtain the images and to deliver HIFU treatment, to achieve this, the Sonablate uses a transducer that has two crystals placed back-to-back.
At frequencies of 6/4 MHz, it can provide good image quality and effective treatment, respectively. The 6 MHz frequency probe provides good resolution of the anterior prostate but has a lower resolution of the posterior prostate margin and rectal wall, compared to higher frequency transducers. Originally, the operator could choose between different crystals depending on the size of the prostate, with a focal length of between 30 and 40 mm.
The Sonablate does not have a real-time imaging system while the treatment is given, but instead alternates between the treatment mode and image acquisition to create an image overlay that is used to detect patient movement; this is achieved by placing images of treatment planning along with images taken during treatment, if both images are aligned, it is indicative that there has been no movement of the patient (Figure 6) [16].
Schematics of the HIFU transducer used in the Sonablate system and the focal point within the tissue.
Insightec, a company located at Tirat Carmel, Israel, developed a system called EXABLATE 2100, which produces high-intensity focused ultrasound real-time guided by MRI. The focused ultrasound is delivered through an endorectal probe, with a 990-element phased-array transducer.
Once the probe is placed inside the rectum, it is filled with degassed water, producing an interface between the prostate and rectal wall. The MRI imaging includes T1-weighted dynamic contrast-enhanced, T2-weighted, and diffusion-weighted sequences, to accurately localize the lesion to be treated; with these images the EXABLATE software lets the user plan, manually contouring the area, including 5 mm tumor-free margins. The system then produces a specific treatment protocol, calculating the energy required and the number of shots to be delivered, avoiding damage to peripheral tissue. A pretreatment low energy targeting is delivered, checked with MRI thermometry. This information is overlapped on the anatomic images. Once confirmed, full power sonications are produced, monitorization is done with real-time MRI thermometry. A successful therapy is considered when the temperature in sonicated tissue achieves a threshold of 65°. A complete treatment is considered when non-perfused areas on MRI are found [17]. During the 2021 AUA meeting, the FDA 510 k clearance was informed.
The prostate therapy system is called TULSA, which stands for Transurethral Ultrasound Ablation. The device is designed to perform prostate tissue ablation in a transurethral approach. The probe is placed through the urethra, once in place, MRI guidance in real-time is used, so the treatment must be done in MRI suites.
In the main module, using high-definition MRI images, the prostate is contoured, during the planning step, the area to be treated is defined, preserving the urethra, and a 3 mm margin of apical prostate immediately above the sphincter [18, 19]. As described by the company [18], it is possible to treat bigger prostates compared with the ultrasound-guided devices.
The TULSA system uses a robotically-driven directional thermal ultrasound; the probe has 10 independent transducers, each of them delivering therapeutic ultrasound, so it is totally customizable, the user can select the number of elements to be used, depending on the length of the prostate. The probe includes a water pump cooling system, and an endorectal cooling device keeps 1 to 2 mm periurethral and rectal protected from thermal damage.
The therapy is done using an intraurethral rotational movement of the probe, creating a “sweeping heating pattern,” directional energy, with in-and-out sonication into the prostate parenchyma. The probe is fixed by an MRI robotic system, controlling the linear and rotational movements. The real-time MRI guidance, shows the thermal changes inside the treated volumes, every 6 seconds, allowing the users to modify the treatment parameters if needed. At the end of the ablation, a complete MRI revision is done, showing with the thermometric measures, all the missing areas that did not receive adequate energy, reassuring a safe and complete treatment [20].
The use of HIFU for the treatment of BPH has been described since 1992. The physical principle for treating an adenoma is not different from whole gland treatment. Tissue temperatures in the range of 80–90° C can produce thermoablation of the treated tissue, and it is possible to induce intra-prostatic cavities comparable to post-TURP effects.
In a series of 50 cases of prostatectomies after treatment with HIFU, it was possible to study the extent of coagulative necrosis caused by HIFU. Madersbacher reports that the prostate volume that can be destroyed during BPH treatment, with a probe with a focal length of 3−5 cm, is 8 cm3, and 14 cm3 with a focal length of 4 cm, so he calculates that approximately 25−30% of the total prostate could be destroyed during the procedure in these patients while keeping the tissue damage on the adjacent tissues minimal [21].
These results encouraged the search for new, less invasive treatment techniques to alleviate lower tract symptoms while reducing possible adverse effects. The main difference in the treatment of BPH against the whole gland lies in the possibility of delimiting the treatment area only to the prostatic adenoma, leaving the rest of the prostate intact.
In order to decrease the rate of complications due to TURP, Ebert et al. reported the use of HIFU for the treatment of prostate enlargement in 50 patients using a Focus Surgery HIFU generator. The short-term results were interesting, with a mean increase in Qmax from 5.7 to 11.6 ml/s at 6 weeks post-treatment, while the incidence of complications seems to be in favor of HIFU versus TURP [22].
In another report by Madersbacher et al., where 98 patients underwent HIFU for BPH, the author obtained similar results of improvement in urodynamic parameters at 12 months post-treatment, however, in the long-term follow-up, they observed that 43.8% of the treated patients had to undergo re-treatment with TURP due to unsatisfactory clinical results [23].
Both authors concluded that this method is promising, and although the long-term results were not satisfactory, they noted that there was a lot of variability in the results due to the heterogeneity of patients with inclusion criteria (prostate size, detrusor activity, middle lobe, etc.) So more protocols are needed to identify the ideal patient for this technique.
Currently, the authors of this chapter are working on the development of a novel technique for the treatment of BPH using a Sonablate HIFU device, with an up-to-date HIFU system and improved protocols: using higher energies, looking to modify the cavitation threshold, to achieve more cavitation than thermal lesions, with promising results in the time of treatment, catheterization and reduction volume of adenoma.
In the last 20 years, the indications for HIFU have expanded, from its original indication for prostate ablation in localized prostate cancer in patients who were not the candidates for radical prostatectomy to hemi ablation or focal therapy for localized disease or as salvage therapy after failed radiation therapy [24].
Whole gland prostate ablation with HIFU as primary treatment is indicated in patients with localized prostate cancer (T1 - T2, Nx, M0) without high-risk factors. They must not have any anorectal pathology that prevents the correct placement of the endorectal transducer.
The physician must be mindful of the anteroposterior diameter of the prostate and the focal point of the HIFU device he or she is using, since the prostatic tissue that is beyond the focal point will remain outside the ablation zone. If the dimensions of the prostate exceed the capabilities of the transducer in the longitudinal or transverse planes, it is possible to reposition the probe and perform the ablation in two or more phases, but it is not possible to reach tissue beyond the focal point.
It is also important to ensure that there are no significant prostatic calcifications, especially if they project posterior acoustic shadow, since the ultrasound beam could bounce off these calcifications, potentially compromising the oncological outcome of the procedure or the integrity of the rectal wall. It is a common practice to perform a TURP prior to HIFU treatment to remove large calcifications or reduce prostate size, and the procedure can be safely performed 6 weeks after TURP.
The HIFU procedure in the prostate is performed using a HIFU generator connected to an endorectal transducer, which contains piezoelectric crystals capable of generating ultrasound waves; this can alternate between high energy for ablation and low energy for image visualization [25].
The endorectal tube is usually connected to a cooling system that maintains the rectal wall at a temperature between 14 and 16°C. The procedure begins with the introduction of the probe and the visualization of the field to be treated. While Ablatherm requires a special surgical table, and the patient is placed in the lateral position, with Sonablate the patient is in a dorsal position and is performed on a standard surgical table.
Treatment planning is a bit different between devices, with the Ablatherm, the prostate is divided into 4 to 6 volumes, and is treated apex to base, slice by slice in an automated process. With Sonablate, the treatment is carried out in 2 to 3 coronal layers, starting with the anterior area and moving towards the posterior zone, in contact with the rectal wall [26].
The prostate normally must be divided into regions or lines of ablation, which correspond to the focal length of the transducer. The transducer can be moved longitudinally and rotated 180° around the axis of the transducer so that the system can plan an ablation line in the longitudinal or transverse plane as long as it is at the same focal length. Although the focal length is fixed, it is possible to move the transducer, which is attached to a mechanical arm, in an antero-posterior direction to achieve the stacking of several treatment planes, making ablation of the entire gland possible.
Once the treatment is finished, the prostate tissue does not undergo immediate necrosis, but rather through a process of progressive ischemia that ends with coagulation necrosis several days after treatment. The thermal damage suffered by the tissue leads to edema and inflammation of the prostate, with an increase in the volume of up to 30% of its base value, this causes an incidence of acute urine retention between 1 and 20% of patients [27].
During this post-surgical period, it is necessary to perform a urinary diversion through a suprapubic or transurethral Foley catheter to ensure urinary drainage, during this time, it takes the prostate tissue to complete the sloughing phase, which is the elimination of necrotic tissue through the urethra, which happens between the first and fourth weeks after surgery; during this time the patient may complain of dysuria and urgency, in addition to obstructive symptoms.
In 2012, Blana et al., analyzed data from 9 European centers, where 1975 patients received whole gland ablation with HIFU (Ablatherm device): clinical stages T1/T2, 356 (18%) were classified as “complete HIFU patients”; 160 (44.9%) had low-risk cancer, 141 patients (39.6%) intermediate, 52 (14.6%) high risk and 3 (0.8%) were unclassified. 205 had a preHIFU TURP. The median PSA Nadir was 0.11 ng/mL (0.78–3.6 ng/mL), obtained at a mean of 14.4 weeks (3.2 months PO-HIFU). Negative biopsies were reported in 182 patients (80.5%): low risk group 86 (86%), intermediate risk 73 (78.5%), and high risk 23 (78.2%). The biochemical disease-free survival rates (DFSR) at 5 years were: low risk 49 cases (88%), intermediate 82 (40%), and high risk 11 (78%). At 7 years: low-risk group 22 (80%), intermediated 14 (82%), and high-risk 3 (64%) [28].
Crouzet reported in 2013: in 1002 patients treated in a single center the following: a median follow-up of 6.4 years. 392 patients received androgen deprivation therapy prior to HIFU, during a median duration of 4.3 months, to shrink the prostate, and it was stopped after HIFU in all cases.
PO-HIFU biopsies were done in 774 patients (77%), being negative in 485 (63%) and positive in 289 (37%). PSA Nadir was at ≤6 months PO-HIFU in all patients, with a median nadir of 0.14 ng/mL.
Biochemical recurrence (Phoenix definition) in 205 cases (21.2%). The biochemical free-survival rates at 5 and 8 years was: low risk 86−76%, intermediate risk 78−63%, and high-risk group 68–57%, respectively (
The adverse effects reported in this series were: urinary incontinence grade 2/3 from 6.4 to 3.1%, mostly managed conservatively and with physiotherapy (94.5%), requiring artificial sphincter in 3.4%, and suburethral sling in 2.1%. Bladder neck or urethral strictures, from 34.9 to 5.9%, resolved with cold knife incision or TURP. 3 patients required a urethral stent. Erections were preserved in 42.3% of patients with a baseline IIEF score ≥ 17 (<70 years: 55.6%; ≥ 70 years: 25.6% (
Dickinson et al. reported medium-term results of 569 patients, in a multicenter study, where they received total gland ablation with HIFU as a treatment for localized prostate cancer, using the Sonablate 500 system.
They found that prostate ablation with HIFU is a treatment effective in cancer control in the medium term, with a 5-year relapse-free rate of 70%, with 87%, 63%, and 58% for low, intermediate, and high-risk groups, respectively. 29% required re-treatment with HIFU.
The adverse events reported were unique urinary tract infection in 58 of 754 (7.7%); repeated infection with epididymo-orchitis 22/754 (2.9%); rectourethral fistula 1/754 (0.13%); 183/754 (88%) continent; and form 236 patients with good erection prior to HIFU, 91 (39%) remained with good erections after HIFU. In the study, they concluded that HIFU is a repeatable outpatient treatment with good oncological control in localized cancer, with a low complication rate [30].
“Focal therapy” and “partial gland ablation” are therapeutic options more frequently considered as good alternatives to treat localized prostate cancer, decreasing morbidity, seen more frequently after radical prostatectomy and external beam radiation.
According to an International Multidisciplinary Consensus on standardized nomenclature and surveillance methodologies, the definition of “focal therapy” describes “a guided ablation of an image-defined, biopsy-confirmed, cancerous lesion with a safety margin surrounding the targeted lesion” [31]. The therapeutic guided term “partial gland ablation” as stated by the consensus, is regional image-guided ablation based on biopsy location. This alternative therapy does not use the identification of lesions by imaging, but anatomical limits, trying to preserve functionality, with a complete tumor treatment. Included in the partial ablations are quadrant therapy, hemiablation, hockey stick, and subtotal ablation.
The main goal of focal therapies is to ablate the prostate cancer focus, with an adequate margin, considered 8 to 10 mm, to have a good oncological control, with preservation of the surrounding tissue, in order to decrease secondary morbidity common in more extensive treatments, maintaining a good quality of life, continence and erectile function.
The frequency of detection of localized prostate cancer has increased importantly with the routinary usage of PSA; since the refinement of the mpMRI of the prostate, and the updated PI RADS, the possibility of defining suspicious lesions is more reliable. Using this high definition T2-weighted MRI images in the fusion systems (Koelis, Artemis, etc.), have improved the precision in targeting smaller and localized cancers.
The description of the “index lesion”, is defined as the tumor lesion responsible for the biological behavior of prostate cancer. The panelist in the consensus, to standardize nomenclature, considered that all MRI-visible lesions with clinically significant cancer should be used as a target for Focal therapies [31, 32, 33]. All these parameters are suggested to be considered as decision-making guides to select patients for focal therapies or partial gland ablation.
It must be remarked, that focal therapy and partial gland ablation are not included in the AUA or EAU guidelines for the prostate cancer treatment, as a consequence we will base on the recommendations suggested in the expert consensus [31] to indicate them.
The clinically significant prostate cancer (CsPC) has been defined as prostate cancers with a volume more than 0.5 cc, or a T3 stage or major in a whole-mount specimen, and at least one core with Gleason score of 3 + 4 or 6, with core length more than 4 mm [34].
The detection of clinically significant prostate cancer (CsPC) has been facilitated with MRI-TRUS, in-bore MRI-targeted biopsy, and cognitive biopsy techniques. In systematic reviews, MRI-targeted biopsies demonstrated that CsPC detection was significatively more frequent than TRUS-guided biopsy, with the relative sensitivity of 1.16 (95% CI 1.02–1.32) compared with TRUS-guided biopsy [34, 35].
In a meta-analysis that included 16 studies with an accumulated number of 1926 patients, the rate of general detection of prostate cancer was similar between MRI-targeted biopsy (sensitivity, 0.85; 95% CI 0.80−0.89) and TRUS-guided biopsy (sensitivity, 0.81; 95% CI 0.70−0.88); in contrast to detection of CsPC by MRI-targeted biopsy, greater than TRUS-target biopsy (sensitivity 0.91; 95% CI 0.87−0.94 vs. 0.76; 95% CI 0.64−0.84), and a lower detection rate of insignificant cancer (sensitivity 0.44; 95% CI 0.26−0.64 vs. 0.83; 95% confidence interval 0.77−0.87, respectively) [36].
Patient selection is a mandatory step to indicate a focal therapy or a partial gland ablation. As mentioned before, a precise image location of a lesion (PI RADS/LIKERT systems) and a pathology report of an index lesion; the agreement about index lesion (that of greater volume and pathology grade) capable of inducing the risk of prostate cancer progression.
The goal to treat the index lesion is to produce an acceptable oncologic control, decreasing morbidity preserving surrounding structures [32, 33]. The proposed selection criteria included: prostate-specific antigen (PSA) level < 10 ng/mL, no Gleason 4 or 5, the maximum length of cancer in each core of 7 mm, and less than 33% of positive cores [37]. In a multicenter study, reporting safety outcomes and complications, the selection criteria included: Gleason score ≤ 4 + 3 = 7b, if unilaterality, clinical stage T1 or T2, PSA levels - < 15 ng/mL, and life expectancy ≥10 years [38].
The definition to perform focal therapy or partial gland ablation depends on a good visualization of tumoral lesion, corroborated by pathology test, within limits of tumor volume that allows safe oncologic margins; in those cases, with multiple cancer lesions in the same parenchymal topography, the recommended treatment is a templated organ-preserving partial gland ablation, which in general uses urethra as anatomic landmark. Figure 7 defines focal and partial ablations [31].
Differences between focal therapy and templated partial gland ablation. Focal therapy: Focused ablation of image-visible, biopsy-confirmed lesion(s) plus a safety margin. Quadrant ablation: Inclusion of all tissue within a quadrant of the prostate. Hemiablation: Inclusion of all tissue within a lateralized hemisphere of the prostate or the anterior half of the prostate. Hockey stick: Destruction of tissue within a lateralized hemisphere and anterior contralateral zone. Subtotal ablation: Inclusion of most of the parenchyma preserving the posterior lateral zone(s). The intention is to preserve at least one neurovascular bundle.
Treatment is accomplished using any of the two available commercial softwares: Focal-one or Sonablate, both systems can import standard DICOM MRI, to fuse and define the treatment zone, or as cognitive guidance.
Using high definition T2-weighted images as a guide, the prostate contour is done and the ROI section is marked, to be used in the HIFU system, the software allows through elastic fusion to match both MR and ultrasound images, to localize the suspicious lesion, and proceed with the therapy, customizing the number of zones, margins, and power to be used; limits and number of shots are defined automatically by the equipment, starting the treatment [15].
The validation of the treatment is done, in the FOCAL ONE system, once the therapy is finished, doing a CEUS volume, injecting microbubbles. The acquired volume shows very clearly the devascularized area. All sectors treated not showing enhancement after microbubbles injection are considered as entirely destroyed; when prostate sectors show enhancement, this tissue can be considered as living tissue (benign and malignant). The images obtained after CEUS can be fused in the initial planning sequence, showing the treated areas, and if needed new areas can be added to complete the ablation [15].
In the Sonablate system, two seconds immediately after sonication, the equipment scans, updating the prostate images in sagittal and axial, and a proprietary system measures the quality of RF caused in the treated tissue, giving a colorimetric scale: orange adequate energy delivered, yellow energy enough to destroy the tissue, green suboptimal energy delivered, and gray not measured.
This TCM system lets the physician replan those suboptimal or not measured spots and retreat, adjusting the energy to achieve the correct lesion. The second and more reliable procedure to validate the effectiveness of each shot, is the presence of cavitation, called “pop corn”, because the change of echogenicity, same as with TCM, 2 seconds after the sonication, the updated scan, shows in real-time the presence of a hyperechoic lesion, that must be evaluated, to control the power delivered, keeping it inside of the treatment box, as mentioned previously, the main goal is to cause extensive controlled cavitation in the treated tissue [39].
The suggested way to evaluate the treated zone, and the peripheral tissues, is Gadolinium-enhanced (non-dynamic) MRI. The immediate images reveal a central zone without enhancement that explains devascularization secondary to the coagulative necrosis, surrounded by an enhanced rim. After six months post-HIFU, a shrinkage of prostate volume is noticed (61% of median volume reduction), with a decrease of the signal intensity on T2-weighted images [15, 40].
In 2018, Guillaumier S. et al., reported a 5-year outcomes study after focal therapy with HIFU. It was a prospective study including 625 patients with localized clinically significant prostate cancer. The study took place from January 1, 2006, to December 31, 2015, the inclusion criteria were: Gleason score 6−9, clinical-stage T1c-3bN0M0, prostate-specific antigen of ≤30 ng/mL.
All patients were followed for 3−6 months PSA, with mpMRI done at 1 year and 1−2 years the following years. All rises in PSA after nadir were evaluated with prostate biopsy or mpMRI, when suspicious with MRI-targeted biopsy. When clinically significant prostate cancer was found on biopsies, in field or out field, a repeat HIFU was offered. 599 patients completed at least 6 months follow-up, and 505 (84%) presented as intermediate of high-risk prostate cancer (D’Amico classification).
The Failure-free survival was: 1 year 99% (95% CI 98−100%), at 2 years 92% (95% CI 90−95%), and at 5 years88% (95% CI 85−91%). Kaplan–Meier estimated at 5 years for low risk 96% (95% CI 91−100%), intermediate risk 88% (95% CI 84–93%), and high risk group 84% (95% CI 78−90%). 8 patients opted for salvage radical prostatectomy, 36 salvage radiotherapy, and 1 androgen deprivation therapy. 10 patients progressed with metastases: Kaplan–Meier estimated for metastases-free survival: 1 year 99.7% (95% CI 99−100%), 3 years 99% (95% CI 98−100%), and 5 years 99% (95% CI 97−100%). Repeat focal HIFU: one done in 112, and two repeat HIFU in 9.56 patients out of 222, required biopsy after HIFU, secondary to PSA rise or mp MRI suspicion; 29 had in-field recurrence, 16 histological evidence of out-field cancer; and 11 patients both in and out-field cancer [41].
As described by Schmid, Schindele et al., in his multicenter study, included 98 men with localized low to intermediate risk prostate cancer, the parameters were median-PSA before HIFU of 6.5 ng/mL (1.03−14.9 ng/mL); clinical T stage ≥2 with cT1 in 76.5% (n = 75), cT2 in 23.5% (n = 23); Gleason score 3 + 3 = 6 in 17.3% (n = 17), 3 + 4 = 7a in 65.4% (n = 64), and 4 + 3 = 7b in 17.3% (n = 17); median prostate volume of 39.6 cc (21.6−135.2 cc); the treated index lesion volume of 10.5 cc (3.9−28.2 cc).
Their evaluation showed the following complications after HIFU therapy: 35 patients (35.7%) had adverse effects during the following 30 days after HIFU treatment with Clavien-Dindo grade ≥ II: 15 points (15.3%) with urinary tract infection and 26 patients (26.5%) with urinary retention. 4 patients (4.1%) needed another procedure (Clavien-Dindo grade IIIa/b). Late post HIFU complications, happening during days 30 to 90 was 2.0%. Considering the cancer location, the most common complications were those located at the anterior base in 50% of cases. When the urethra was ablated, the complications were present in 48.8% of cases (20 of 41), considered as a significant risk factor during the 30 days post-HIFU (odd ratio = 2.53; 95% confidence interval: 1.08−5.96; P = 0.033) [38].
Recurrence of prostate cancer after EBRT is a common condition, reported in up to 46% of patients treated with radiation. The therapeutic options used to control the progression are salvage prostatectomy, usually indicated in selected cases, because of technical difficulties, and higher morbidity; salvage cryotherapy, hormone blockage, and salvage HIFU. Biochemical recurrence (using PSA levels) in relation to the ASTRO-AUA-EAU guidelines, is a safe parameter to detect local recurrences, between 10−30% of cases. Extension studies must be included in the staging process, mpMRI and PET SCAN PSMA have shown excellent options to discard metastatic involvement.
Ideal patients considered as candidates for salvage HIFU must have PSA levels up to 2 ng/mL according to the ASTRO-Phoenix guidelines, correlated with extension studies as mpMRI or PET SCAN PSMA that will show suspicious tumors in the prostate, biopsy should be used as a confirmatory method; patients with metastatic involvement should be offered another type of procedure but HIFU. Additionally, candidates should have a Gleason score ≤ 8, and clinical-stage ≤T1-T3aNoMo.
Fulfillment of the guidelines can assure a better prognosis among prostate cancer patients treated with HIFU, since case selection is a determinant factor for a successful result, as described in a 2011 evaluation that was performed on a group of 84 men with biochemical failure after EBRT and a whole-gland salvage HIFU. Results have demonstrated that 93% of them were discharged within 23 hours following treatment, and only 20% (17 of 84 patients) needed an intervention for bladder obstruction. Within a follow-up of 19.8 months, 25% (21 of 84 patients) of the cohort presented a residual cancer detected on biopsy after salvage HIFU [42]. It is noteworthy that repeated HIFU procedures are a high-risk factor for rectal fistula development.
In a 2017 prospective study at University College London Hospitals and NHS Basingstoke Trust, in 150 men who received salvage HIFU between 2006 and 2015, the Kaplan–Meier overall survival at 60 months was 92% and among complications, UTI was 11.3% (17 of 150 patients) and bladder neck strictures of 8%. In addition, 87.5% remained pad-free at 2 years among those pad-free at baseline [43].
High-Intensity Focused Ultrasound or Focused Ultrasound Surgery is an emerging image-guided therapy for obstructive benign prostatic hyperplasia and prostate cancer.
With the advent of new methodologies in MRI, specifically multiparametric MRI; the possibility of fusioning the MR images in real-time ultrasound scans, changed the accuracy of targeting biopsies, and recently the therapy targeting to improve control of focalized lesions.
Recently, the usage of MRI guidance with EXABLATE and TULSA-PRO, taking advantage of thermometric scanning, allowed more accurate treatments, limited by the need for MRI facilities. In the case of whole gland ablation, it is compared in outcomes with radical prostatectomy and EBRT, with less adverse effects.
The most common consideration of less aggressive treatments for clinically significant prostate cancer made the focal therapy a growing alternative, only limited at this time for the availability of good technical mpMR images, necessary to assess accurately the parenchymal lesions. The general results in different centers make HIFU a highly promising therapeutic option.
Our deepest thanks to:
Prof. Narendra Sanghvi, Focus-Surgery and Sonablate Corp.
Alex Gonzalez, Sonablate Corp.
Rodrigo Chaluisan, Sonablate Corp. In memoriam.
The authors declare to use a Sonablate device for BPH and prostate cancer treatments, since 2005, participate in the proctoring teaching system of Sonablate Company and participate in a BPH protocol with Sonablate Company.
All video materials referenced in this chapter are available to download here: https://bit.ly/33T5UxZ.
PSA | prostate-specific antigen |
HIFU | high intensity focused ultrasound |
TURP | transurethral resection of prostate |
BPH | benign prostate hyperplasia |
mpMRI | multiparametric magnetic resonance image |
EBRT | external beam radiotherapy |
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recognition that the human genome cannot provide answers to the etiology of a disorder, changes in the proteins expressed by a genome became a focus in research. 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Dr. Shang serves as a senior research engineer at the China Institute of Water Resources and Hydropower Research (IWHR) and was awarded as a distinguished researcher at National Taiwan University in 2017.",institutionString:"China Institute of Water Resources and Hydropower Research",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"China Institute of Water Resources and Hydropower Research",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null,series:{id:"25",title:"Environmental Sciences"}}},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"August 3rd, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:107,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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