Высокоинтенсивный фокусированный ультразвук в лечении рака предстательной железы

Abstract

Background. High intensity focused ultrasound (HIFU) is a method of delivering acoustic energy to a focal point, thus destroying it and causing coagulation necrosis. Repeating the fires, the whole needed volume of organ can be treated without damaging the adjacent tissue. Objective. To establish the clinical efficacy and safety of HIFU in the treatment of prostate cancer on the basis of the authors’ 3-year experience in applying this technique. Materials and methods. A total of 101 patients with biopsy-proven prostate cancer (and 2 more patients had only high-grade PIN) have been treated in our clinic using an Ablatherm® device. Seventy-one of them were enrolled in this study. They were followed from sixth months to three years at a regular interval, the follow-up included PSA measurement and control sextant biopsies. Results. The median PSA nadir 1.5Р3.0 months after treatment ranged from 0.10 (in the low-risk localized prostate cancer group) to 2.50 ng/mL (in patients with a disseminated process). Negative control biopsies were in 75—80% of patients with localized prostate cancer and in 64—75% of the patients with disseminated process. Of all the patients, 91% underwent transurethral resection of the prostate before HIFU treatment. Such combination improved the efficacy of HIFU and reduced the treatment-related morbidity significantly. Grades 2 and 3 stress incontinence was observed in 1.9 and 0.9% of the patients, respectively. No other severe complications were recorded. Erectile function was preserved in 69.94% of the patients. Conclusion. Our results demonstrated the efficacy and low-associated morbidity of HIFU. HIFU does not exclude other treatment options and is repeatable if needed. HIFU seems to be a valid alternative treatment for patients who are not suitable for radical surgery.