671 HORMON RESISTANT PROSTATE CANCER TREATED BY ROBOTIC HIGH INTENSIVE ULTRASOUND

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2010671 HORMON RESISTANT PROSTATE CANCER TREATED BY ROBOTIC HIGH INTENSIVE ULTRASOUND Christian Chaussy, Stefan Thueroff, and Regina Nanieva Christian ChaussyChristian Chaussy More articles by this author , Stefan ThueroffStefan Thueroff More articles by this author , and Regina NanievaRegina Nanieva More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1058AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hormonal resistant prostate cancer (HRPCa) is an increasing problem in prostate cancer therapy, because of longer patient survival under hormonal ablation. We analyze how local tumor ablation by robotic high intensity focused ultrasound (rHIFU) influences disease progression and whether this local therapy shows differences in efficacy treating local and systemic disease. METHODS 55 patients with PSA progression under definitive hormonal ablation (HA) with local biopsy proven tumor and a minimum follow up of 1 year after rHIFU for local HRPC therapy. HRPC was defined as tripple PSA increase under long term (> 2 years) hormonal ablation. rHIFU was performed in one session in spinal anesthesia, accompanied by TUR and performed completly at 3 MHz by Ablatherm® (EDAP-TMS, Lyon). Efficacy and side effect profile is analyzed in a max. follow up of 9.5 years. RESULTS Inclusions: age 76(62-88); Staging: T2: 20%, T3-4: 80%; N+: 15%, M+: 11%; Gleason: 7.5(4-9); HA duration (months): 48(4-137); PSAtr (at HIFU therapy): 8ng/ml (0.9-491; 57% <10ng/ml, 16% >20ng/ml). Efficacy: PSA Nadir: 1.8ng/ml (0-148): this integrates 37% <4ng/ml and 28% >20mg/ml. time to Nadir (months): 1.7(0.2-8.5). PSA reduction: 80% (N0/M0), 65% (N+/M+). Follow up time (months): 21(6.6-114), Last PSA: 7.9 ng/ml (0-320); Deaths within follow up: PCa related: 7, not PCa related: 5; unknown reason: 10. Alive: 23/55 (40%) HRPC patients after median 21 months. Side effects (HIFU related postoperative acc. Clavien (1-5)): 15% (Clavien 1-3 in 8/55 cases only). Any adverse events in follow up: 23.6% (50% local obstructive reasons). CONCLUSIONS Local adjuvant tumor ablation by “TUR & rHIFU” reduces PSA by 80% in local disease and 65% in systemic disease. This new minimal invasive, single session, adjuvant concept in treatment of HRPC showed its high efficacy as additional therapy in prostate cancer therapy in an most unfavourable patient group. 40% of the patients were still living after a follow up of 23 months with a PSA below entryPSA at treatment inclusion. Adjuvant local tumor ablation by rHIFU achieved a longer survival in good life quality. It was accompanied by a low and moderate side effect rate. It substituted or preserved more invasive or systemic therapies as salvage prostatectomy or chemotherapy for later use. Muenchen, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e262 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Chaussy More articles by this author Stefan Thueroff More articles by this author Regina Nanieva More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...