antigen (PSA) level of ≤ 28 ng/mL and a prostate volume of ≤ 40 mL. Negative biopsy rates with the Ablatherm TM device (EDAP TMS S.A., Vaulx-en-Velin, France) were 64-93%, and a PSA nadir of ≤ 0.5 ng/mL was achieved in 55-84% of patients. The 5-year actuarial disease-free survival rates were 60-70%. The most common complications were stress urinary incontinence, urinary tract infection, urethral/bladder neck stenosis or strictures, and erectile dysfunction. For the Ablatherm device, the rate of complications has been significantly reduced over the years, due to technical improvements in the device and the use of transurethral resection of the prostate before HIFU. In conclusion, HIFU as primary therapy for prostate cancer is indicated in older patients ( ≥ 70 years) with T1-T2 N0M0 disease, a Gleason score of < 7, a PSA level of < 15 ng/mL and a prostate volume of < 40 mL. In these patients HIFU achieves short-term cancer control, as shown by a high percentage of negative biopsies and significantly reduced PSA levels. The median-term survival data also seem promising, but long-term follow-up studies are needed to further evaluate cancerspecific and overall survival rates before the indications for primary therapy can be expanded.
Oncological results of the laparoscopic approach are difficult to compare with those of open surgery. However, recent series have not reported unusual tumour dissemination or a higher rate of recurrence with this approach. Laparoscopic techniques are not yet standard of care in invasive urothelial carcinomas. Long-term assessment is ongoing and awaited.
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