Whole-gland High-intensity Focused Ultrasound Research Articles

V10-10 NOVEL TECHNIQUE: PERIVESICAL FAT ROTATIONAL FLAP FOR RECTAL INTERPOSITION COVERAGE IN SALVAGE ROBOTIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023V10-10 NOVEL TECHNIQUE: PERIVESICAL FAT ROTATIONAL FLAP FOR RECTAL INTERPOSITION COVERAGE IN SALVAGE ROBOTIC RADICAL PROSTATECTOMY Alexander Hwang, Matthew Watson, Michael Tonzi, and Amar Singh Alexander HwangAlexander Hwang More articles by this author , Matthew WatsonMatthew Watson More articles by this author , Michael TonziMichael Tonzi More articles by this author , and Amar SinghAmar Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 21st-century urologic oncologist has a spectrum of treatment modalities for localized prostate cancer that can be tailored to patients. For patients with low-risk prostate adenocarcinoma, multiple non-prostatectomy treatment options include whole-gland radiotherapy, brachytherapy, proton therapy, cryotherapy, and high-intensity focused ultrasound (HIFU) therapy. Salvage therapies for recurrent localized prostate cancer include surgical (e.g. radical prostatectomy and cystoprostatectomy) and non-surgical (e.g. whole-gland brachytherapy, whole-gland cryotherapy, and whole-gland HIFU). Surgical salvage therapies are plagued with significant morbidity carrying the increased risk for urinary incontinence (>50% requiring use of pads) rectal injuries (3.3-50% requiring diversion in setting of radiation), and anastomotic stricture (17-32%) (1). METHODS: We describe a 67-year-old male who initially presented to our practice after undergoing whole-gland HIFU due to biopsy proven grade group 1 prostate cancer. Unfortunately, he developed biochemical recurrence with a PSA of 2.0 and biopsy discovered grade group 3 localized prostate cancer. After discussing the associated risks, the patient elected to undergo a salvage robotic radical prostatectomy (sRRP). We modified our sPPP approach by performing a posterior dissection to free the seminal vesicles prior to dropping the bladder which allowed us to mobilize our flap through the posterior defect and interpose the flap over the anterior rectal wall and tether it to periurethral tissue with absorbable suture. Please see accompanying video for procedural details. RESULTS: The patient had a negative cystogram and denied bowel or urinary symptoms. He presented to the emergency department 3 months post-operatively complaining of nonspecific abdominal pain and computed tomography demonstrated the perivesical flap appropriately interposed in its new heterotopic location. CONCLUSIONS: The perivesical tissue flap is an anatomically accessible and vascularized tissue that can be mobilized to interpose between a radiated, tenuous anterior rectal wall and vesicourethral anastomosis to reinforce perfusion and prevent fistulas. This technique allows expansion to the armamentarium of reconstructive urology. Source of Funding: No sources of funding to disclose. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e929 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Hwang More articles by this author Matthew Watson More articles by this author Michael Tonzi More articles by this author Amar Singh More articles by this author Expand All Advertisement PDF downloadLoading ...

Oncological Long-term Outcome After Whole-gland High-intensity Focused Ultrasound for Prostate Cancer—21-yr Follow-up

BackgroundOwing to the morbidity of established radical treatment options for prostate cancer, alternative whole-gland and focal treatment strategies have emerged. High-intensity focused ultrasound (HIFU) is one of the most studied sources for tissue ablation and has been used since the 1990s. ObjectiveTo provide 21-yr oncological long-term follow-up data of an unselected series of patients who underwent whole-gland HIFU for nonmetastatic prostate cancer. Design, setting, and participantsA total of 674 patients were treated between November 1997 and November 2012 in one university center. Outcome measurements and statistical analysisThe oncological outcome was assessed by biopsy failure–free survival (BFFS), salvage treatment–free survival (STFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Multivariable Cox proportional hazard regression analyses were performed to estimate the prognostic relevance of clinical variables. Results and limitationsIn total, 560 patients were included into the evaluation and the median follow-up was 15.1 yr, with a range up to 21.4 yr. At 15 yr, CSS rates for low-, intermediate-, and high-risk patients were 95%, 89%, and 65%, respectively; MFS, STFS-1 (salvage treatment other than HIFU), STFS-2 (salvage treatment including repeat HIFU), and BFFS rates were 91%, 85%, and 58%; 77%, 63%, and 29%; 67%, 52%, and 28%; and 82%, 73%, and 47%, respectively. Preoperative high-risk category was an independent predictor of inferior OS, CSS, MFS, STFS, and BFFS. ConclusionsAlthough whole-gland HIFU achieved good long-term cancer control in low- and intermediate-risk patients, high-risk patients should not be treated routinely by HIFU. Intermediate-risk patients achieve high CSS and MFS rates, but a relevant salvage treatment rate has to be reckoned with. Long-term data after whole-gland therapy might help derive implications for focal treatment sources and patient selection. Patient summaryLong-term data after whole-gland high-intensity focused ultrasound (HIFU) therapy are crucial to prove its oncological efficacy, and may help derive implications for focal treatment strategies and patient selection. In this context, whole-gland HIFU achieved good long-term cancer control up to 21 yr in low- and intermediate-risk prostate cancer (PCa) patients. Owing to considerably inferior long-term cancer control, it should not routinely be used in high-risk PCa patients.

Analysis of oncological outcomes of whole-gland therapy with high-intensity focused ultrasound for localized prostate cancer in clinical and technical aspects: a retrospective consecutive case-series analysis with a median 5-year follow-up

Purpose This study aimed to analyze technical and clinical factors related to oncological outcomes in patients with localized prostate cancer (PC) who were treated with whole-gland high-intensity focused ultrasound (HIFU). Materials and Methods From 2007–2014, patients diagnosed with localized PC who underwent whole-gland HIFU were consecutively included retrospectively. Biochemical failure was defined according to the Phoenix ASTRO guidelines. The relationship between oncological outcomes and technical and clinical factors was evaluated. Results The study cohort included 428 patients. The median age was 67 years, and the median prostate-specific antigen level was 7.61 ng/mL. Patient risk classifications were low (n = 102), intermediate (n = 240), and high (n = 86). Biochemical disease-free survival rates of patients with HIFU for localized PC in the total, low-, intermediate-, and high-risk groups according to D’Amico risk groups over a median follow-up period of 5 years (range 9-144) were 68.4%, 80.4%, 65.6%, and 61.6%, respectively. In multivariate logistic regression analyses to predict biochemical failure of the treatment, neoadjuvant hormonal therapy (NHT) in the high-risk group (OR 0.225, p = 0.015), and compression method in the low- (OR 0.178, p = 0.030), intermediate- (OR0.291, p < 0.0001), and high-risk (OR 0.316, p = 0.049) groups were significant factors that reduced the risk of biochemical failure after treatment. There were no significant differences in complications between patients treated with compression and those treated conventionally. Conclusions NHT may potentially improve oncological outcomes for patients in the high-risk group, and compression methods can improve the oncological outcomes of whole-gland therapy with HIFU.

The primary treatment of prostate cancer with high-intensity focused ultrasound: A systematic review and meta-analysis.

Background:We systematically evaluated the evidences on oncological and functional outcomes of high-intensity focused ultrasound (HIFU) as the primary treatment for localized prostate cancer (PCa).Methods:A systematic review was used Medline, Embase, and the Cochrane Library from the inception of each database. The review analyzed the oncological and functional outcomes of HIFU in the treatment of PCa. The RevMan 5.3 software was used for quantity analysis incidence of complications.Results:Twenty-seven articles were included for analysis with a total of 7393 patients. Eighteen studies investigated the whole-gland HIFU, and the duration of follow-up ranged from 2 to 168 months. After whole-gland HIFU, the mean prostate-specific antigen (PSA) nadir was found to be 0.4 to 1.95 ng/mL and the mean time to PSA nadir was 2.4 to 5.4 months. The rate of positive biopsy after HIFU was 4.5% to 91.1%. Meta-analysis revealed the incidences of urinary incontinence, impotence, urinary obstruction, retention, and infection was 10%, 44%, 15%, 11%, 7%, respectively. Nine studies investigated partial-gland HIFU, and the duration of follow-up was 1 to 131 months. After partial-gland HIFU, the mean PSA nadir was 1.9 to 2.7 ng/mL and the mean time to PSA nadir 5.7 to 7.3 months. The rate of positive biopsy after HIFU in the treatment area was 14% to 37.5%. Meta-analysis revealed the incidences of urinary incontinence, impotence, urinary obstruction, retention, and infection was 2%, 21%, 2%, 9%, 11%, respectively.Conclusions:Early evidence suggested the partial-gland HIFU was safer than whole-gland HIFU, and they had similar oncological outcomes. More prospective randomized controlled trials of whole-gland and partial-gland HIFU for PCa was needed.

V14-06 CETRUS; CONTRAST-ENHANCED TRANS-RECTAL ULTRASOUND TO MONITOR POST-TREATMENT RECURRENCE AFTER FOCAL HIFU OF PROSTATE

You have accessJournal of UrologyProstate Cancer (V14)1 Apr 2020V14-06 CETRUS; CONTRAST-ENHANCED TRANS-RECTAL ULTRASOUND TO MONITOR POST-TREATMENT RECURRENCE AFTER FOCAL HIFU OF PROSTATE Aliasger Shakir*, Atsuko Fujihara, Tsuyoshi Iwata, Alessandro Tafuri, Cacciamani Giovanni, Suzanne Palmer, Inderbir Gill, and Andre Luis Abreu Aliasger Shakir*Aliasger Shakir* More articles by this author , Atsuko FujiharaAtsuko Fujihara More articles by this author , Tsuyoshi IwataTsuyoshi Iwata More articles by this author , Alessandro TafuriAlessandro Tafuri More articles by this author , Cacciamani GiovanniCacciamani Giovanni More articles by this author , Suzanne PalmerSuzanne Palmer More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Andre Luis AbreuAndre Luis Abreu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000982.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the role of contrast enhanced trans-rectal ultrasound (CeTRUS) in the follow-up evaluation of patients who underwent focal High Intensity Focused Ultrasound (HIFU) for prostate cancer (PCa). METHODS: From our IRB-approved database (HS-17-00749), we identified 22 patients who underwent focal hemi-gland HIFU ablation of the prostate and had follow-up CeTRUS, mutiparametric MRI (mpMRI) and prostate biopsy (PBx) between 6 months to 1 year after HIFU. Salvage or whole-gland HIFU patients were excluded. CeTRUS was performed following a 2.5cc intravenous bolus of ultrasound contrast agent (LUMASON). Two-minute cine images of the regions of interest were recorded. CeTRUS findings were compared with mpMRI and the results of PBx. CeTRUS images were evaluated qualitatively. A PIRADS v2 score of 3 or higher was considered positive. Clinically significant PCa (csPCa) is defined as ISUP Grade Group (GG) ≥ 2 and non-csPCa is defined as ISUP Grade Group (GG) < 2. RESULTS: At baseline, median age and PSA was 65 year old and 5.1ng/ml. Six (26%) patients had low-risk, 13 (57%) had intermediate-risk and 3 (13%) had high-risk PCa. Post HIFU, median PSA nadir, and reduction in PSA were 1.0 ng/mL and 72%, respectively. On follow-up PBx with a median follow of 16M, 12 (55%) patients had cancer, 6 (27%) patients had csPCa, 3 (14%) patients had in-field recurrences, 9 (40%) patients had out-field recurrences, and 10 (45%) patients had a negative biopsy. Among them, three (14%) patients had in-field csPCa, 3 (14%) had out-field csPCa, 0 (0%) had in-field ncsPCa, and 6 (27%) had out-field ncsPCa. In the 3 patients with in-field csPCa (Table), MRI detected 2 (66%) lesions and CeTRUS detected 2 (66%) lesions. However, the patients with lesions detected by MRI and CeTRUS were not the same. One patient had a lesion detected by both MRI and CeTRUS, one patient had a lesion detected by MRI only and one patient had a lesion detected by CeTRUS only. Overall, among the 3 patients with in-field csPCa, 3 (100%) had lesions detected by either imaging modality. CONCLUSIONS: CeTRUS enhancement pattern showed high correlation with in-field csPCa on follow up PBx. CeTRUS and MRI were able to identify more csPCa compared to MRI alone. The addition of CeTRUS to MRI can be helpful in the follow up after focal HIFU and aid detection, and localization of csPCa. Source of Funding: This study was funded in part by the R01 grant CA205058-01 from the National Institutes of Health/ National Cancer Institute (M.C.S, I.S.G. and A.L.A.). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1307-e1308 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aliasger Shakir* More articles by this author Atsuko Fujihara More articles by this author Tsuyoshi Iwata More articles by this author Alessandro Tafuri More articles by this author Cacciamani Giovanni More articles by this author Suzanne Palmer More articles by this author Inderbir Gill More articles by this author Andre Luis Abreu More articles by this author Expand All Advertisement PDF downloadLoading ...

Survival and quality of life outcomes of high-intensity focused ultrasound treatment of localized prostate cancer.

BackgroundTo evaluate the survival and quality of life (QoL) outcomes of high-intensity focused ultrasound (HIFU) whole-gland ablation for localized prostate cancer.MethodsOver 8 years, men with localized prostate cancer treated with whole-gland HIFU were prospectively followed. Transrectal prostate ablation was performed under general anesthesia with Sonablate-500® (Sonacare Medical©, Charlotte, North Carolina, USA). The primary outcome was failure-free survival defined as no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer–specific mortality. Secondary outcomes included both survival outcomes and QoL measures.ResultsOf 70 men, 29.7% had International Society of Urological Pathology (ISUP) grade 1, 43.8% ISUP 2, 10.9% ISUP 3, and 15.6% ISUP 4 disease. At median follow-up of 83.4 months, overall mortality was 8.6% and prostate cancer–specific mortality 0%. Failure-free survival was 78.2% at 5 years and 71.2% at 7 years. Of all men, 7.1% of men developed metastases, with median metastasis-free survival of 75.4 months. There was negligible post-HIFU urinary incontinence or lower urinary tract symptom with a median Male Urogenital Distress Inventory score of 32 at 6 months and 33 at 12 months and median IPSS of 4 at 6 months and 3 at 12 months. Median Radiation Therapy Oncology Group rectal toxicity score was 0 throughout. In men who had mild or no erectile dysfunction at baseline (International Index of Erectile Function ≥17), the mean International Index of Erectile Function score declined to 37% from 23.5 at baseline to 14.7 at 12 months.ConclusionAt median follow-up of 7 years, whole-gland HIFU appears to have comparable survival outcomes with other cohort studies involving radical prostatectomy and radiotherapy patient. It has low impact on QoL, preserved urinary continence, and erectile function approximate to nerve-sparing prostatectomy. Whole-gland HIFU presents a potential alternative minimally invasive and safe option for the treatment of localized prostate cancer.

High-intensity Focused Ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: predictors of disease response.

ABSTRACTBackgroundSome men with localized radio-recurrent prostate cancer may benefit from salvage high-intensity focused ultrasound (HIFU). Herein, we describe oncologic outcomes and predictors of disease response after salvage whole gland HIFU from our prospective cohort.Materials and MethodsPatients with localized radio-recurrent prostate cancer were prospectively enrolled from January 2005 to December 2014. Participants had to meet both biochemical and histological definitions of recurrence. Exclusion criteria included the receipt of prior salvage therapy, presence of metastatic disease, and administration of ADT in the 6-months prior to enrollment. Participants were treated with a single session of whole-gland HIFU ablation with the AblathermTM device (EDAP, France). The primary endpoint was recurrence-free survival (RFS), defined as a composite endpoint of PSA progression (Phoenix criteria), receipt of any further salvage therapy, receipt of ADT, clinical progression, or death. Kaplan-Meier survival analysis was used to determine the primary end-point and stratifications were used to determine the significance of 6 pre-specified predictors of improved RFS (TRUS biopsy grade, number of study entry TRUS biopsy cores positive, palpable disease at study enrollment, pre-HIFU PSA, an undetectable post-HIFU PSA nadir, and receipt of prior hormone therapy). Survival analysis was performed on participants with a minimum of 1-year follow-up.ResultsTwenty-four participants were eligible for study inclusion with a median follow-up of 31.0 months. Median PSA at study entry was 4.02ng/ml. Median time to PSA nadir was 3 months after treatment and median post-HIFU PSA nadir was 0.04ng/ml. Median 2-year and 5-year RFS was 66.3% and 51.6% respectively. Of our 6 prespecified predictors, an undetectable PSA nadir was the only significant predictor of improved RFS (HR 0.07, 95% CI 0.02-0.29, log-rank P<0.001). One participant underwent an intervention for a urethral stricture. No participants developed osteitis pubis or rectourethral fistulae.ConclusionsSalvage HIFU allows for disease control in selected patients with localized radio-recurrent prostate cancer. An undetectable PSA nadir serves as an early predictor of disease response.

Oncological and functional outcomes of elderly men treated with HIFU vs. minimally invasive radical prostatectomy: A propensity score analysis

AimTo assess outcomes of whole gland high-intensity focused ultrasound (HIFU) as compared with minimally-invasive radical prostatectomy (MIRP) in elderly patients. Materials & methodsPatients aged ≥70 years with, cT1-cT2 disease, biopsy Gleason score (GS) 3 + 3 or 3 + 4 and preoperative PSA ≤10 ng/mL were submitted to either whole-gland HIFU or MIRP. Propensity-score matching analysis was performed to ensure the baseline equivalence of groups. Follow-up visits were routinely performed assessing PSA and urinary function according to the International Continence Score (ICS) and the International Prostatic Symptoms Score (IPSS) questionnaires. Estimated rates of salvage-treatment free survival (SFS) overall-survival (OS), cancer-specific survival (CSS) and metastasis-free survival (MTS) were assessed and compared. ResultsOverall, 84 (33.3%) and 168 (66.7%) patients were treated with HIFU and MIRP, respectively. MIRP was associated with a 5-yrs SFS of 93.4% compared to 74.8% for HIFU (p < 0.01). The two groups did not differ in terms of OS and MTS. No cancer-related deaths were registered. Patients treated with HIFU showed better short-term (6-mos) continence outcomes [mean-ICS: 1.7 vs. 4.8; p = 0.005] but higher IPSS mean scores at 12-mos assessment. A comparable rate of patients experiencing post-treatment Clavien-Dindo grade ≥III complications was observed within the two groups. ConclusionsWhole-gland HIFU is a feasible treatment in elderly men with low-to intermediate-risk PCa and could be considered for patients either unfit for surgery, or willing a non-invasive treatment with a low morbidity burden, although a non-negligible risk of requiring subsequent treatment for recurrence should be expected.

High-intensity focused ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: Predictors of disease response.

135 Background: Some patients with localized radio-recurrent prostate cancer (PCa) may have long-term recurrence-free (RFS) survival with salvage high-intensity focused ultrasound (HIFU). In this study, we describe our previously unreported oncologic outcomes and predictors of disease response after salvage HIFU. Methods: Participants were prospectively enrolled in this study from January 2005 to December 2014 if they had localized radio-recurrent prostate cancer. Participants had to meet both biochemical (PSA nadir+ 2ng/ml) and histologic (positive biopsy) definitions of recurrence. Study exclusion criteria included the receipt of prior salvage therapy, presence of metastastatic disease, and receipt of ADT in the 6-months prior to enrollment. Participants were treated with a single session of whole-gland HIFU ablation with the Ablatherm device (EDAP, France). The primary endpoint of this study was RFS, defined as a composite endpoint of PSA progression (PSA nadir + 2 ng/ml), receipt of any further salvage therapy, receipt of ADT, clinical progression, or death. Kaplan-Meier survival analysis was used to determine the primary end-point and stratifications were used to determine the significance of 6 pre-specified predictors of improved RFS (undetectable PSA nadir, low TRUS biopsy grade, &gt;3 TRUS biopsy cores positive, pre-HIFU PSA&lt;4ng/ml, receipt of prior ADT and presence of pre-HIFU palpable disease). Survival analysis was performed on participants with a minimum of 1-year follow-up. Results: Twenty-four participants were eligible for study inclusion with a median follow-up of 31.0 months. Median PSA at study entry was 4.02 ng/ml. Median time to PSA nadir was 3 months after treatment and median post-HIFU PSA nadir was 0.04 ng/ml. 2-year and 5-year RFS were 66.3% and 51.6% respectively. An undetectable PSA nadir was the only significant predictor of improved RFS (HR 0.07, 95% CI 0.02-0.29, log-rank P&lt;0.001). No participants developed a rectourethral fistula. Conclusions: Salvage HIFU allows for disease control in select patients with localized radio-recurrent prostate cancer. An undetectable PSA nadir serves as an early predictor of disease response.

Comparisons of oncological and functional outcomes between primary whole-gland cryoablation and high-intensity focused ultrasound for localized prostate cancer

The aim of this study was to conduct a prospective, single-institutional comparison for primary whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in localized prostate cancer with respect to oncological and functional outcomes. From October 2008 to December 2013, a total of 114 and 120 patients with primary whole-gland cryoablation and HIFU for localized prostate cancer, respectively, were enrolled in the study. Prostate-specific antigen (PSA) biochemical recurrence defined by Phoenix definition, salvage treatment-free rate, metastasis-free rate, and PSA biochemical recurrence-free survival analyzed using the Kaplan–Meier method were for oncological outcomes. Functional outcomes included complications and serial International Index of Erectile Function (IIEF)-5 scores, International Prostate Symptom Score (IPSS), and related quality of life (QoL) scores. During the mean follow-up duration of approximately 2 years, the PSA biochemical recurrence rates of the two groups were similar (cryoablation 25.4 %, HIFU 18.3 %). In terms of functional outcomes, patients with HIFU had significantly lower IPSS (5.70 vs. 9.04 at 24 months; p = 0.030), lower erectile dysfunction rate (65.6 vs. 88.0 %; p = 0.015), and higher IIEF-5 score (9.36 vs. 4.18 at 24 months; p = 0.028) than patients with cryoablation. In this study, both primary whole-gland cryoablation and HIFU demonstrated good oncological outcomes for localized prostate cancer. We validated the safety of the two treatment modalities and identified the importance of combined HIFU and transurethral resection of the prostate. The HIFU patients experienced better urinary function improvement and more possible sexual function preservation than the cryoablation patients; therefore, HIFU may provide better quality of life for patients with localized prostate cancer.

MP17-16 URETHRA-SPARING TREATMENT WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2015MP17-16 URETHRA-SPARING TREATMENT WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR LOCALIZED PROSTATE CANCER Sunao Shoji, Mayura Nakano, Tetsuro Tomonaga, Hiroshi Fujikawa, Kazuyuki Endo, Akio Hashimoto, Toshiro Terachi, and Toyoaki Uchida Sunao ShojiSunao Shoji More articles by this author , Mayura NakanoMayura Nakano More articles by this author , Tetsuro TomonagaTetsuro Tomonaga More articles by this author , Hiroshi FujikawaHiroshi Fujikawa More articles by this author , Kazuyuki EndoKazuyuki Endo More articles by this author , Akio HashimotoAkio Hashimoto More articles by this author , Toshiro TerachiToshiro Terachi More articles by this author , and Toyoaki UchidaToyoaki Uchida More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.858AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the oncological outcomes and the longitudinal change in quality of life (QOL) of patients treated with urethra-sparing high-intensity focused ultrasound (HIFU), compared with whole-gland HIFU for localized prostate cancer. METHODS Patients receiving urethra-sparing or whole-gland HIFU (Sonablate®) as the primary therapy for localized prostate cancer without transurethral resection of the prostate were included in the study. Patients with negative findings of the transition zone biopsies and magnetic resonance imaging received urethra-sparing HIFU. Oncological and functional outcomes, along with longitudinal changes in QOL were analyzed. RESULTS Comparing the patients treated with urethra-sparing (n=54) (Fig.1a) with those treated with whole-gland HIFU (n=254), there were no significant differences in negative biopsy rates upon follow-up (83% vs. 87%; p=0.4) or biochemical disease-free survival rates (BDFS) (81% vs. 77%; p=0.5) (Fig.1b). In functional outcomes, there were significant differences in International Prostate Symptom Score (IPSS) (11 vs. 14, p=0.022) at 3 months, IPSS QOL (3 vs. 4, p=0.038) at 3 months, maximum urinary flow rate (mL/s) (12.8 vs. 9.4 at 3 months, p=0.014; 13.2 vs. 11.2 at 6 months, p=0.048), and residual urine volume (mL) (32 vs. 58 at 3 months, p<0.0001; 30 vs. 38 at 6 months, p=0.010; at 12 months, p=0.038). In QOL, there were significant differences in Functional Assessment of Cancer Therapy - General (FACT-G) (90 vs. 80 at 3 months, p=0.020) and FACT-Prostate (P) (36 vs. 30 at 3 months, p=0.030; 37 vs. 32 at 6 months, p=0.044), but no significant difference in International Index of Erectile Function (IIEF) -5. In complication rates, there was a significant difference in the rate of urethral stricture at 6 months (5.6% vs. 16% within 3 months, p=0.044; 3.7% vs. 10% from 4 to 6 months, p=0.048), but no significant difference in erectile function at 24 months (63% vs. 65%, p=0.8). CONCLUSIONS There was no significant difference in the oncological outcomes between urethra-sparing and whole-gland HIFU patients in this study. However, the urinary function of patients treated with urethra-sparing HIFU was superior to patients treated with whole gland HIFU within 6 months post-treatment. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGolan R, Bernstein A, McClure T, Sedrakyan A, Patel N, Parekh D, Marks L and Hu J (2017) Partial Gland Treatment of Prostate Cancer Using High-Intensity Focused Ultrasound in the Primary and Salvage Settings: A Systematic ReviewJournal of Urology, VOL. 198, NO. 5, (1000-1009), Online publication date: 1-Nov-2017. Volume 193Issue 4SApril 2015Page: e182 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunao Shoji More articles by this author Mayura Nakano More articles by this author Tetsuro Tomonaga More articles by this author Hiroshi Fujikawa More articles by this author Kazuyuki Endo More articles by this author Akio Hashimoto More articles by this author Toshiro Terachi More articles by this author Toyoaki Uchida More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy.

To report our experience with salvage high-intensity focused ultrasound (HIFU) in patients with local failure after brachytherapy for prostate cancer. Whole-gland HIFU was administered to prospectively recruited patients with local histologic failure after brachytherapy at 2 institutions in the United Kingdom and Canada. Functional and oncologic outcomes of the procedure were analyzed. Nineteen patients underwent the treatment, 12 with Gleason sum 7 and 5 with Gleason sum 8 at recurrence. Thirteen men had grade-3a or -3b complications by the Clavien system; there were no grade-4 or -5 complications. The most common postoperative complication was dysuria, which was self-limited. Three men developed rectourethral fistulae. The overall continence rate was 68.4%. At a mean follow-up of 51.6 months, all men were alive. The overall biochemical recurrence-free survival rate was 66.7% and 73.3% using the "nadir prostate-specific antigen level" +1.3 ng/mL and +2 mg/ml criteria, respectively. This study is limited by the small cohort size, relatively short follow-up period, and heterogeneity of the patient population. In this, the largest prospective series to date, we demonstrate that salvage HIFU for locally recurrent prostate cancer after failed primary brachytherapy has encouraging disease control results, albeit with a relatively high complication rate.

Complete high-intensity focused ultrasound in prostate cancer: outcome from the @-Registry

To analyze data on patients with localized prostate cancer who were treated with complete high-intensity focused ultrasound (HIFU) prospectively captured within a voluntary HIFU user database (@-Registry). The @-Registry includes data from consecutive patients treated with Ablatherm (EDAP-TMS) HIFU at nine European Centres during the period 1994 and 2009. For this analysis, the data repository was reviewed for information on patients with localized prostate cancer (T1 -- T2) treated with complete (whole-gland) HIFU on the basis of an anterior-posterior prostate height of ≤24 mm and a treated volume >120% of the prostate volume. Patients were regularly followed with PSA measurement and biopsy. Biochemical failure was defined for this study as PSA nadir +2 ngml(-1) (Phoenix definition). Disease-free survival was based on a biopsy, retreatment and biochemical data. Patients were risk group-stratified using the D'Amico classification system. The median follow-up was 2.8 years for the 356 patients included in the analysis. The majority could be classified as either low (44.9%) or intermediate risk (39.6%); 14.6% patients were classified as high risk. The median (mean, s.d.) PSA nadir was 0.11 ng ml(-1) (0.78 and 3.6), achieved at a mean (s.d.) of 14.4 (11.6) weeks after HIFU. Follow-up biopsies on 226/356 (63.5%) patients revealed an overall negative biopsy rate of 80.5% (182/226); there was no statistically significant difference in positive biopsy rate by risk group-stratification. Actuarial freedom from biochemical recurrence at 5 and 7 years according to the Phoenix definition was 85% and 79%, respectively. Disease-free progression rates at 5 and 7 years were 64% and 54%, respectively. Whole-gland prostate HIFU as primary monotherapy for localized prostate cancer achieves a recurrence-free survival in short-term analysis as assessed by prostate biopsy and serum PSA endpoints in a majority of patients.

Prostatic cancer surveillance following whole-gland high-intensity focused ultrasound: comparison of MRI and prostate-specific antigen for detection of residual or recurrent disease

This retrospective study compares dynamic contrast-enhanced (DCE) MRI with the serial prostate-specific antigen (PSA) measurement for detection of residual disease following whole-gland high-intensity focused ultrasound (HIFU) therapy of prostate cancer. Patients in whom post-HIFU DCE-MRI was followed within 3 months by ultrasound-guided transrectal biopsy were selected from a local database. 26 patients met the study inclusion criteria. Serial PSA levels following HIFU and post-HIFU follow-up MRI were retrieved for each patient. Three radiologists unaware of other investigative results independently assessed post-HIFU MRI studies for the presence of cancer, scoring on a four-point scale (1, no disease; 2, probably no disease; 3, probably residual disease; and 4, residual disease). Sensitivity, specificity and receiver operating characteristic (ROC) analysis were performed for each reader, post-HIFU PSA nadir and pre-biopsy PSA level thresholds of >0.2 and >0.5 ng ml(-1). The sensitivity of DCE-MRI for detection of residual disease for the three readers ranged between 73% and 87%, and the specificity between 73% and 82%. There was good agreement between readers (κ = 0.69-0.77). The sensitivity and specificity of PSA thresholds was 60-87% and 73-100%, respectively. The area under the ROC curve was greatest for pre-biopsy PSA (0.95). DCE-MRI performed following whole-gland HIFU has similar sensitivity and specificity and ROC performance to serial PSA measurements for detection of residual or recurrent disease.

Whole‐gland salvage high‐intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy

Whole-gland high-intensity focused ultrasound (HIFU) has been used as salvage therapy for local recurrence following external beam radiation therapy for decades. This article describes the use of the Sonablate 500 HIFU system in the salvage setting. An evaluation was performed of a consecutive group of men with biochemical failure after external beam radiation therapy with histologically proven local recurrence and bone-scan and pelvic magnetic resonance imaging to exclude macroscopic metastases, and who chose to have whole-gland salvage HIFU (Sonablate 500) at 2 centers (3 expert HIFU surgeons at each center). The modified Clavien system was used to categorize adverse events and validated questionnaires for functional outcomes. Progression following HIFU treatment was defined as ASTRO-Phoenix criteria (prostate serum antigen [PSA] >nadir+2 ng/mL) and/or a positive biopsy and/or start of hormone therapy. Eighty-four men underwent whole-gland salvage HIFU (2004-2009). Median age, pretreatment serum PSA, and biopsy Gleason score was 68 years (range, 64-72 years), 4.3 ng/mL (range, 1.9-7.9 ng/mL), and 7 (range, 6-7), respectively. Mean follow-up was 19.8 months (range, 3.0-35.1 months). After salvage HIFU, 62% of the men were pad-free and leak-free. Mean International Index of Erectile Function-5 point score fell from 8.8 to 4.7 (P < .001). International Prostate Symptoms Score and RAND-SF36 scores were not affected. Two men developed rectourethral fistulae after 1 salvage procedure. A further 2 fistulae occurred in the 6 men undergoing a second salvage HIFU. Intervention for bladder outlet obstruction was needed in 20% (17 of 84 patients). If PSA nonresponders were included, 1- and 2-year progression-free survival rates were 59% (50 of 84 patients) and 43% (36 of 84 patients), respectively. If PSA nonresponders were excluded, 1- and 2-year progression-free survival rates were 62% (48 of 77 patients) and 48% (37 of 77 patients), respectively. Salvage whole-gland HIFU is a high-risk procedure. Although its use in early cancer control is promising, strategies to better identify metastatic disease prior to salvage therapy and reduce local toxicity are needed to improve on this.