Introduction:We investigate the effectiveness of prostate-specific antigen (PSA) screening for prostate cancer. We compare the characteristics of 2 sets of patients: (1) those in whom prostate cancer was detected via PSA screening (the PS group) and (2) those in whom prostate cancer was detected at the outpatient office (the non-PS group). Methods: Between 2002 and 2010, prostate cancer was detected in 315 patients by PSA screening. Their age, initial PSA level, pathological findings in biopsy specimens, clinical stage, and prognosis were compared with those of 497 prostate cancer patients diagnosed at the outpatient office of the Department of Urology, Hiroshima University, in the same period. Results: The rates of patients with initial PSA higher than 50 ng/ mL, with a Gleason score of 8 or higher, and with clinical stage D were significantly lower in the PS group than those in the non-PS group. The 5-year overall survival and cancer-specific survival in the PS group was 91.3% and 98.2%, respectively; these results were significantly better than those in the non-PS group (86.4%, p = 0.0178, and 94.9%, p = 0.0112, respectively). A Cox hazard analysis showed that PSA screening was an independent predictive factor for cancer-specific survival. Conclusions: Although our study is limited by its retrospective nature and small size, the present data indicate that prostate cancer detected in the PS group showed earlier stage, lower grade, and better prognosis than in the non-PS group.

Background: Salvage radiotherapy has been used as the treatment for patients with local recurrence after radical prostatectomy. However, the therapy is time-consuming and it experiences adverse effects of some kind. Simple and less invasive treatment is highly anticipated. Objectives: To evaluate the outcomes of salvage transrectal high-intensity focused ultrasound (HIFU) therapy for patients with localized recurrence of a vesicourethral anastomosis (VUA) after radical prostatectomy. Material and methods: Sixteen patients with suspected local recurrence of a VUA after prostatectomy were treated with HIFU. All patients had prostate-specific antigen (PSA) failure (>0.2 ng/ml), positive findings of a VUA with biopsy and/or MRI, TRUS and CT, and no distant metastasis by CT, MRI and bone scintigraphy before HIFU. Recurrence after HIFU was determined by PSA failure (>0.2 ng/ml), histological findings, metastasis and start of systemic therapies. Results: HIFU treatments were performed in 16 patients, and followed-up for 7-159 months (median 46.5). The pre-HIFU PSA levels ranged from 0.318 to 3.1 ng/ml. Sonication time ranged from 9-42 min. All patients had a decline of PSA after HIFU, and 88% of the PSA nadir was <0.2 ng/ml. Recurrence free survival (RFS) rates of 5 year were 31.3%. Nadir PSA was significantly associated with recurrence, whereas initial PSA, pre-HIFU PSA, duration and risk group after prostatectomy were not. There were no intraoperative adverse effects. In the 1-3 months after HIFU, there was some difficulty voiding in 4 cases (grade 1), urgency incontinence in 3 cases (grade 1 or 2). Conclusion: HIFU therapy for local recurrence after prostatectomy may become a feasible salvage therapeutic option because of its ease and simple procedure.

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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).