Abstract
Objectives: To evaluate the outcomes and prognosis of high-intensity focused ultrasound (HIFU) therapy for patients with localized prostate cancer, and identify suitable candidates for this therapy by investigating the predictive factors. Methods: The 224 patients (low 54, intermediate 111 and high-risk patients 59) with T1-2 stage were treated using the Sonablate device and followed for over 12 months after treatment. Recurrence was determined based on histological findings, prostate-specific antigen (PSA) failure and local or distant metastasis. The factors which are predicting variables with potential effects were investigated by Kaplan-Meier and multivariate analysis. Results: A total of 255 treatment sessions (193 with one, 31 with two) were performed. No patients died of prostate cancer, but 15 died of other causes and 14 patients were lost during follow-up. The 7-year recurrence-free survival (RFS) rates in all patients were 75%, and 5-year RFS rates were 98%, 84% and 59% in the low, intermediate and high-risk patients respectively. In the 216 patients who underwent histological examination at 6 months or later after HIFU, 25 (12%) were positive. In 77 patients with recurrence after first-HIFU, the second treatments were hormonal therapy and HIFU. Of the 31 patients who underwent a second HIFU, the 5-year RFS rates were 64%, and 5-year RFS rates were 100%, 74% and 33% in the low, intermediate and high-risk patients. The significant predictor for recurrence was risk-group, T-stage (T1 vs T2), Gleason score (≤3 + 4 and ≥4 + 3), pretreatment PSA (<10 vs ≥10 ng/ml) and nadir PSA (<0.1 vs ≥0.1 ng/ml). In 111 patients with intermediate-risk, T-stage and nadir PSA were significantly associated with outcomes. Conclusions: Prognosis of HIFU for Patients with localized prostate cancer was good, and the low and intermediate-risk patients with T1-staging are suitable indications for HIFU. Effective predictors for outcomes were risk-group, T-stage, Gleason score, pretreatment PSA and nadir PSA.
Highlights
In recent years, with the high incidence of prostate cancer worldwide, the proportion of early stage prostate cancer has increased
Since May 2003, we have treated patients with localized prostate cancer who were not suitable for, or did not desire radical prostatectomy or radiotherapy, and we have reported the efficacy and safety of high-intensity focused ultrasound (HIFU) ablation for patients with prostate cancer [10] [11]
Our results suggest that HIFU is an effective treatment in patients with low and intermediate-risk localized prostate cancer, but it is not effective for high-risk patients
Summary
With the high incidence of prostate cancer worldwide, the proportion of early stage prostate cancer has increased. Since May 2003, we have treated patients with localized prostate cancer who were not suitable for, or did not desire radical prostatectomy or radiotherapy, and we have reported the efficacy and safety of HIFU ablation for patients with prostate cancer [10] [11]. According to these experiences, HIFU therapy has the advantages of fewer complications, simplicity of the procedure, shorter treatment times, and the potential for a repeat treatment [11]. We retrospectively examine the long-term outcomes of the first and second HIFU therapies, prognosis and RFS, and consider which patients are suitable for this treatment
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