Abstract
Objectives. To assess the treatment outcomes of a single session of whole gland high intensity focused ultrasound (HIFU) for patients with localized prostate cancer (PCa). Methods. Response rates were defined using the Stuttgart and Phoenix criteria. Complications were graded according to the Clavien score. Results. At a median follow-up of 94months, 48 (44.4%) and 50 (46.3%) patients experienced biochemical recurrence for Phoenix and Stuttgart definition, respectively. The 5- and 10-year actuarial biochemical recurrence free survival rates were 57% and 40%, respectively. The 10-year overall survival rate, cancer specific survival rate, and metastasis free survival rate were 72%, 90%, and 70%, respectively. Preoperative high risk category, Gleason score, preoperative PSA, and postoperative nadir PSA were independent predictors of oncological failure. 24.5% of patients had self-resolving LUTS, 18.2% had urinary tract infection, and 18.2% had acute urinary retention. A grade 3b complication occurred in 27 patients. Pad-free continence rate was 87.9% and the erectile dysfunction rate was 30.8%. Conclusion. Single session HIFU can be alternative therapy for patients with low risk PCa. Patients with intermediate risk should be informed about the need of multiple sessions of HIFU and/or adjuvant treatments and HIFU performed very poorly in high risk patients.
Highlights
During the last decade, proactive screening for prostate cancer (PCa) led to a dramatic stage migration resulting in proportionally more men being diagnosed at early stages while the tumour is still organ confined [1]
In the present single-centre study, we evaluated, at a median follow-up of 92 months, the oncological outcomes of single-session whole gland high intensity focused ultrasound (HIFU) treatment of localised PCa in a unique case series of 110 patients treated between September 2001 and December 2012
In our institution the upper volume limit for HIFU procedures is set to 40 cc and patients with prostates exceeding this threshold are offered androgen deprivation therapy (ADT) which was always discontinued at the time of therapy
Summary
Proactive screening for prostate cancer (PCa) led to a dramatic stage migration resulting in proportionally more men being diagnosed at early stages while the tumour is still organ confined [1]. Conventional established treatment options for organ confined PCa range from active surveillance to whole gland radical therapy [2] Both radical prostatectomy (RP) and external-beam radiotherapy (EBRT) have undergone significant technical developments during the last decade and excellent long term cancer control data are available to support their clinical use [1]. These modalities are often associated with significant risk of treatment related complications that detrimentally affect quality of life [3, 4]. The ability of HIFU to achieve thermoablation of prostatic lesion was proven histologically on operative specimen [5], on MRI imaging [6], and on posttreatment biopsies [7, 8]
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