Transrectal high‐intensity focused ultrasound for treatment of localized prostate cancer

Abstract

Objectives:To assess the long-term outcomes of transrectal high-intensity focused ultrasound (HIFU) for patients with localized prostate cancer. Methods: From May 2003 to present, 137 consecutive patients with T1-2 prostate cancer were treated using the Sonablate 500 and then followed for more than 12 months after their last HIFU treatment. A prostate biopsy was routinely carried out at 6 months and serum prostate-specific antigen (PSA) was measured every 3 months after HIFU. Oncological outcomes as well as treatment-related complications were assessed. Disease-free survival (DFS) was judged using the Phoenix definition (PSA nadir + 2 ng/mL), negative histological findings and no local or distant metastasis. Results:The median follow up after HIFU was 36 months (range 12-84 months). No patients received adjuvant therapy during this period. The PSA nadir occurred at 2 months after HIFU and the median level was 0.07 ng/mL (0.01-2.01 ng/mL). Of the 133 patients who underwent prostate biopsy or transurethral resection of the prostate at 6 months or later after HIFU, six were positive for cancer cells (4.5%). There were no major postoperative complications, but urge incontinence (16 cases) and dysuria (33 cases) occurred after removal of the urethral catheter. The 5-year DFS rate was 78% based on these criteria, and 91%, 81% and 62% in the low-, intermediate-and high-risk group, respectively. Conclusions: HIFU represents an effective, repeatable and minimally invasive treatment. It is particularly effective for low-and intermediate-risk patients, and it should be considered as an option for localized prostate cancer.

Telematisch unterstützte Interventionen in der Onkologie

“…Besondere Bedeutung besitzt die Applikation fokussierten Ultraschalls jedoch beim Prostatakarzinom, für welches es zu einer ernst zu nehmenden Alternative zur Resektion avancierte. So konnte bezüglich des onkologischen Ergebnisses derart behandelter T1-2-Prostatakarzinome eine Rezidivrate von unter 5% beobachtet werden [17].…”

High‐intensity focused ultrasound therapy for prostate cancer

“…However, complications, including three rectal burns, were reported in nine of the 14 patients (64%) in this pilot trial. Table 3 summarizes the largest clinical series reported and the outcomes achieved with both the Ablatherm and Sonablate HIFU devices, mainly for the primary treatment of localized prostate cancer 19–33 …”

“…The median PSA nadir was 1.2 ng/mL and was achieved after a mean time of 12 months, which is a higher value and longer period than those reported in other studies. In most cases, the PSA nadir is reached within 6 months after HIFU treatment 19–23,27–35 . Of the 84 patients who had control biopsies, 55 (65%) had positive biopsies.…”

“…Since 1996, HIFU has been used for the treatment of patients with primary localized prostate cancer and salvage therapy for recurrence after radiation (Table 1). 19–38 The recent use of focal therapy in specific patients with early‐stage localized prostate cancer and salvage therapy in patients with recurrence of vesico‐urethral anastomotic lesions after radical prostatectomy has been reported (Table 1). 39–44 …”

Focal Treatment Alternatives in Prostate Cancer

“…Th e records of one hundred and thirty seven patients having PCa undergoing HIFU were evaluated retrospectively in a study 34 . During a mean follow up period of 36 months, disease relapsed in 22% of the patients.…”