Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

Abstract

Purpose: To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU). Materials and Methods: Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were: PSA ≤ 10 ng/mL, ≤ 3 positive biopsies with only 1 lobe involved, clinical stage ≤ T2a, Gleason score ≤ 7 (3+4), negative CT scan and bone scan. Hemi-ablation of the prostate was performed with the Ablatherm (R) device. Survival, complication rates and urinary continence were evaluated. Control biopsies were performed at 1 year. Treatment failure was defined as a positive biopsy or need for salvage therapy. Results: Twelve patients with a mean age 70 years were included. Median follow-up was 10 years. Control prostate biopsies were negative in 11/12 (91%) patients. Overall survival was 83% (10/12) and cancer specific survival was 100% at 10 years. Two patients died from other causes. Recurrence free survival was 90% (95% CI; 0.71-1) at 5 years, and 38% (95% CI; 0.04-0.73) at 10 years. Five patients had salvage therapy with repeat HIFU (n = 1) or hormonal therapy (n = 4) and all salvage patients were alive at 10 years. No patients developed lymph node or bone metastasis. No patients suffered from urinary incontinence. International Prostate Symptom Score was stable at 1 year. Complications included two urinary tract infections and one episode of acute urinary retention. Conclusions: Hemi-prostate ablation with HIFU can be safely performed in selected elderly patients with adequate longterm cancer control and low complication rates. Results from larger prospective studies using improved imaging techniques and extensive biopsy protocols are awaited.

Twelve Core Template Prostate Biopsy is an Unreliable Tool to Select Patients Eligible for Focal Therapy

“…There are few published data on follow-up FT series for PCa. Despite good functional results and percentages of residual tumour in the treated areas being between 0 and 23% [14,15,16,17], there are sparse descriptions of the pathological findings in the untreated areas. When this data is described, the presence of PCa in the contralateral lobe detected in follow-up PB ranges from 10 to 13.7% [13,14].…”

Effects of High‐Intensity Focused Ultrasound for Treatment of Abdominal Lymph Node Metastasis From Gastric Cancer

“…No evident injury has been observed around or above the tissues penetrated by ultrasound. 20,21 High-intensity focused ultrasound also elicits other biological effects, such as proapoptosis and an improved cellular immune response, 22 in addition to the direct eradication by thermal effects. Clinical studies have indicated that HIFU has been extensively recognized as a local treatment not only to control local tumors but also to relieve pain and improve the quality of life of patients without severe side effects.…”

The new era of minimally invasive interventions for prostate cancer: robot-assisted laparoscopic radical prostatectomy and focal therapy

“…The authors report urinary tract infections in two patients and acute urinary retention in one, but a stabilization of international prostate symptom scores at 1 year and overall cancer-specific survival of 100%. 50 Another group reported early cancer control with a cohort of 20 patients treated with hemiablation. The trifecta of continence, erections, and cancer control was achieved in 89% of patients.…”