High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series

Abstract

Background:The use of minimally invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy.Methods:An analysis of men with organ-confined prostate cancer treated with transrectal whole-gland HIFU (Sonablate 500) between 1 February 2005 and 15 May 2007 was carried out in two centres. Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated.Results:A total of 172 men were treated under general anaesthetic as day-case procedures with 78% discharged a mean 5 h after treatment. Mean follow-up was 346 days (range 135–759 days). Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P=0.005). Antibiotics were given to 23.8% of patients for presumed urinary tract infection and the rate of epididymitis was 7.6%. Potency was maintained in 70% by 12 months, whereas mild stress urinary incontinence (no pads) was reported in 7.0% (12 out of 172) with a further 0.6% (1 out of 172) requiring pads. There was no rectal toxicity and no recto-urethral fistulae. In all, 78.3% achieved a PSA nadir ⩽0.5 μg ml−1 at 12 months, with 57.8% achieving ⩽0.2 μg ml−1. Then, 8 out of 13 were retreated with HIFU, one had salvage external beam radiotherapy and four chose active surveillance for small-volume low-risk disease. Overall, there was no evidence of disease (PSA <0.5 μg ml−1 or negative biopsy if nadir not achieved) after one HIFU session in 92.4% (159 out of 172) of patients.Conclusion:HIFU is a minimally invasive, day-case ablative technique that can achieve good biochemical outcomes in the short term with minimal urinary incontinence and acceptable levels of erectile dysfunction. Long-term outcome needs further evaluation and the inception of an international registry for cases treated using HIFU will significantly aid this health technology assessment.

High-Intensity Focused Ultrasound (HIFU) - An Alternative Choice in Prostate Cancer Treatment

“…The first UK series was reported by Ahmed et al and published on the British Journal of Cancer. 172 men were treated with HIFU with excellent result: 92.4% of patients had no recurrence after a mean follow-up of 346 days 17 . Blana et al published a series of 140 men treated with HIFU, reporting good oncological outcome in long-term follow-up (6.4 years), demonstrating the effective long-term cancer control achieved with HIFU in patients with low-or intermediate-risk localised prostate cancer 18 .…”

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

“…Patients were 100% pad-free immediately following treatment. Erectile function sufficient for intercourse occurred in 70% by 2 weeks, and at 3 months, 95% had erections sufficient for penetration (19). In a prospective study, comparing whole gland and focal therapy with HIFU, these two options where equivalent for short-term cancer control.…”

What is the best radiological method to predict the actual weight of the prostate?

“…A preference for the use of perineal, robotic, or retropubic approaches is also based on the prostate volume (11,12). Lastly, prostate volume is used for calculating the radiotherapy doses to be delivered in external beam or brachytherapy, and in planning therapies such as high-intensity focused ultrasound for prostate cancer (13,14).…”