PTTA HIFU in the Treatment of Localized Prostatic Cancer

Abstract

Transrectal prostatic tumor thermal ablation with High Intensity Focused Ultrasound (HIFU) is an alternative treatment of prostate cancer in non surgical patients. Material and Methods From November 2001 and October 2003, 116 patients (89 with localized prostatic cancer and 27 re-treatments after surgery, radiotherapy or HIFU) were treated with transrectal HIFU at 3 MHz and 5 sec lesions (Ablatherm,) in our department. All patients were deemed unfit for or refused surgery. In 6 patients < 70 years old with a single positive prostatic biopsy, we used a nerve sparing strategy trying to save the neurovascular bundle of the non affected lobe. The procedure was always performed in spinal anaesthesia and combined with a TURP. Urethral catheter was always removed within 24 hours. A suprapubic tube was left for a longer period. The treatment was planned under ultrasound guidance and computer driven. Results 49 patients reached a follow-up of 12 months. Median P.S.A. nadir was 0.1 ng/mL. At 12 months of follow-up prostatic biopsy were negative in 100% (5/5) low risk patients (LRP), 82.6% (19/23) intermediate risk patients (IRP) and 71.4% (15/21) high risk patients (HRP). 5 HRP with positive biopsy at 6 months were treated again with HIFU. 6 patients treated after anastomotic recurrency post RRP reached a follow up of 6 months: all biopses at 6 months were negative and mean PSA was 0,46 ng/mL. 8 patients with recurrency after external bean radiotherapy got local control of disease in 75% of cases with PSA ≤ 0,5ng/mL in 37.5% of cases. Conclusions HIFU is a feasible alternative treatment of localized prostate cancer in non surgical cases. It is well tolerated by the patients with a short hospital stay and acceptable side effects and does not contraindicate any other local treatment in case of failure.