Control Of Prostate Cancer By Transrectal HIFU In 227 Patients

UroToday.com - High-intensity focused ultrasound (HIFU) is a novel treatment for localized prostate cancer. Dr. Poissonnier and associates from Lyon, France report their outcomes in 227 patients treated with HIFU in the epub version of European Urology.

HIFU produces ultrasound waves that are generated by a transducer and result in necrosis of prostate tissue. In this study population, 227 men were treated with a TURP and HIFU in the same setting to treat their prostate cancer (CaP) and decrease their risk of urinary retention (by the transurethral resection). Prostate biopsies were performed at 3 months post HIFU and PSA was followed. Biochemical failure was defined as PSA >1ng/ml with 3 consecutive rises.

Mean patient age was 69 years, mean pretreatment PSA was 7ng/ml and 90% of patients were clinical stage T1c or T2. Two-thirds of patients had a Gleason score of 2-6. In the study cohort, 76 patients received neo-adjuvant androgen deprivation therapy. The mean number of HIFU session was 1.4.

Post-HIFU biopsies were negative for malignancy in 86%. Of the 31 (14%) with residual cancer, 19 received adjuvant treatment, such as radiotherapy or androgen deprivation therapy. Mean PSA nadir was 0.38ng/ml and mean PSA velocity was 0.25ng/ml/yr. The actuarial disease-free survival rate at 5 years was 66% for the whole population. This was much better if the pre-treatment PSA was <4ng/ml (90%) as compared to between 4.1 and 10ng/ml (57%). Neo-adjuvant deprivation did not appear to affect outcome in the authors' analysis.

Incontinent and bladder neck stricture rates decreased from 28% and 31% to 9% and 6%, respectively as more experience with the procedure was acquired. A total of 39% of patients potent prior to the procedure retained potency after the HIFU. When the authors select for patients who had a "nerve-sparing" procedure, erectile function was preserved in 69%.
This report is important early data on HIFU.

Reviewed By Christopher P. Evans, M.D.

Eur Uro 2006; Article in Press
by Laura Poissonnier, Jean-Yves Chapelon, Olivier Rouviиre, Laura Curiel, Raymonde Bouvier, Xavier Martin, Jean Michel Dubernard, Albert Gelet
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