High-intensity focused ultrasound therapy for clinically localized prostate cancer

Abstract

The efficacy of high-intensity focused ultrasound (HIFU) used for the treatment of localized prostate cancers has been demonstrated over the past decade. We present our early results after HIFU used as a single session in patients with clinically localized prostate cancer. A total of 58 patients were treated using the Ablatherm HIFU device with or without transurethral resection of the prostate (TURP). HIFU failure was defined as the presence of a cancer remnant on repeated biopsies or three consecutive increases in the prostate-specific antigen (PSA) >/=1.0 ng/ml. The mean follow-up was 14 months (range, 6-21 months). After HIFU treatment, 78% of patients had a decreased PSA level to <0.5 ng/ml within 3 months. The median value of the last PSA was 0.6 ng/ml and the median nadir PSA was 0.2 ng/ml. The success rates of HIFU were 85, 77 and 47% in low-, intermediate- and high-risk groups, respectively. The HIFU failure rate was closely associated with clinical stage, presence of cancer on TURP chips and nadir PSA on univariate analysis. However, the only significant predictor for HIFU failure was the nadir PSA value by multivariate Cox regression analysis. The operation-related complications were minimal. Although both the period and number of patients were limited to evaluate the clinical efficacy, HIFU appears to be a safe and effective treatment option in selected patients with prostate cancer.

Current status of high-intensity focused ultrasound for prostate cancer: Technology, clinical outcomes, and future

“…In 1996, Gelet et al [26] reported a preliminary experience with an Ablatherm prototype in almost the same indications. From these first papers to the contemporary series, several publications with both devices have confirmed the HIFU efficacy as a primary procedure in the aforementioned indications with short-and mid-term results [11][12][13][14][15][16][17][18][19][20][21][22].…”

“…In most cases, the PSA nadir is reached within 6 months following the procedure, making it possible to have early feedback on treatment efficacy. Many studies have demonstrated that the PSA nadir significantly predicts HIFU success [16,21,28]. Lee et al [16] proposed to carefully monitor those patients in whom the PSA nadir has not dropped below 0.5 ng/mL.…”

“…Many studies have demonstrated that the PSA nadir significantly predicts HIFU success [16,21,28]. Lee et al [16] proposed to carefully monitor those patients in whom the PSA nadir has not dropped below 0.5 ng/mL. Blana et al [23••] reported on a long-term series a PSA nadir less than or equal to 0.5 ng/mL in 68.4% of patients and demonstrated a significant inverse relationship between the 5-year disease-free survival rate and the PSA nadir, with 83% being observed in patients achieving a PSA nadir of 0.5 ng/mL or less versus 34% when the nadir is greater than 0.5 ng/mL.…”

Novel techniques for the treatment of localized prostate cancer: Evidence of efficacy?

“…Two institutions [16,17] routinely perform a TURP at the same time as the patient receives HIFU, whereas the third institution [18] does not. These studies found negative post-HIFU biopsies in 80% to 87% of patients who underwent biopsies and a mean PSA nadir between 0.2 and 0.33 ng/mL reached within a mean of 8 weeks to 4.4 months after the procedure.…”

There is no role for focal therapy in prostate cancer

“…These therapies are ablative, so that a threshold PSA appears most appropriate (e.g., PSA > 0.5 μg/L), but dynamic definitions as used for radiotherapy have also been proposed. 15,16 This will need to be addressed with top priority if focal therapy is to be studied in a systematic fashion.…”