Robotic high-intensity focused ultrasound (rHIFU) for the prostate cancer treatment

Abstract

Abstract.Introduction & Objectives: rHIFU shows a successful treatment for localized prostate cancer (PC). Here we explored the effectiveness of the rHIFU treatment for the prostate cancer, hormone-resistant prostate cancer (HRPC) and failure after external beam radiotherapy (EBRT) and radical prostatectomy (RPE).Materials & Methods: 748 patients were treated in our center between Sep 2007 -February 2012: 137 -hormone-resistance (median time before hormone-resistance 25 months), 286 -received neoadjuvant hormone therapy 6 months, 293 -no treatment before HIFU, 32 -after the EBRT failure. 667 patients underwent TURP+rHIFU, 81 only rHIFU (volume prostate <40cc). Mean follow-up is 38 months (range 3-52). All patients were divided into 3 groups: low risk progression (Gleason <7, stage T1-2N0M0, PSA<20, n= 465), high risk progression -(Gleason ≤9, stage T2-3N0M0, PSA <60, n= 251), after EBRT and RPE failure (n= 39). The mean age of the whole group of patients were 70 (52-89) years, mean prostate volume -39 (5,5-108) cc.Results: Median PSA level 12 months after rHIFU treatment were 0,04 (0-2,24) ng/ml -low risk group, for high risk group -0,5 (0-48,4) ng/ml, with failure after EBRT and RPE-0,5 (0-3,2) ng/ml; 36 months after rHIFU treatment were 0,5 (0,02-3,6) ng/ml -low risk group, for high risk group -3,2 (0-21,38) ng/ml, with failure after EBRT and RPE -1,7 (0-9,8) ng/ml. Patients with low risk had 4,5% of progression, with high risk PC -25%, with failure after EBRT and RPE -19,6%. Kaplan-Meir analyses of the total group indicated that the risk of progression after 1 year follow-up was 10%, the risk of progression was 23% after 4 years of follow-up.Complications: incontinence I -17,5%, incontinence II -7,7%, stricture -18,2%, fistula -0,3 %.Conclusions: Our experience shows that rHIFU ablation is safe, minimally invasive, effective treatment with moderate side effects for the PC, hormone-resistant prostate cancer, rHIFU also may be used as a salvage therapy after EBRF. Further studies are required.