Between 2002 and 2010, 22 patients were treated with salvage HIFU using the Sonablate 500 machine. Initial CaP therapy was external beam radiotherapy (n=14), brachytherapy (n=5) or proton beam therapy (n=3). Eligibility criteria for salvage HIFU were biopsy proven local recurrence and no distant metastasis. HIFU was not performed if there was rectal stenosis, prostate volume >40cc, or prostate calcifications >1cm.
The Sonoblate systems used included an ultrasound generator, transrectal probes, a probe positioning system and a continuous cooling system. The HIFU uses low-energy (4mHz) ultrasound for imaging and high-energy ablative ultrasound (1,300-1,680W/cm2) pulses for tissue destruction. Patients had HIFU under general anesthesia. Treatment was performed using 3- and 4-cm probes. A post-procedure prostate biopsy was performed in 12 patients at 6-12 months, and biochemical failure was defined by the Phoenix definition. No adjuvant therapy was given during the follow-up period. One patient had a second HIFU treatment for residual disease.
Median patient age was 65 years and median serum PSA was 14.5 ng/ml prior to initial therapies. Six of 22 patients were receiving adjuvant androgen deprivation therapy at the time of HIFU therapy, started prior to referral for HIFU. Risk stratification was low, intermediate, and high in 4, 7, and 11 patients, respectively. Median PSA and Gleason score prior to HIFU were 4.0ng/ml and 7, respectively. Median follow-up was 24 months. No man died of CaP during follow-up and one of 12 men had residual cancer on the follow-up prostate biopsy. The bDFS rate was 52% at 5 years. For low, intermediate, and high-risk groups, the bDFS rates were 100%, 86%, and 14%, respectively. Grade 3 urethral strictures occurred in 4 of 22 patients and were treated with periodic dilatation. Urinary incontinence occurred in 4 men, a rectourethral fistula in one patient who then required a colostomy and suprapubic catheter. This was reversed several months later.
Uchida T, Shoji S, Nakano M, Hongo S, Nitta M, Usui Y, Nagata Y
BJU Int. 2011 Feb;107(3):378-82
10.1111/j.1464-410X.2010.09518.x
PubMed Abstract
PMID: 21265984
UroToday.com Prostate Cancer Section
