PURPOSE: To describe the long-term cancer control and morbidity of high intensity focused ultrasound (HIFU) with neoadjuvant transurethral resection of the prostate (TURP), the risk of metastatic induction by TURP and the evolution of HIFU application and technology over time.
PATIENTS AND METHODS: Prospective Harlaching HIFU database was searched for patients with primary localized PCa (T1-2, N0, M0, PSAi < 50 ng/ml) and follow-up > 15 months; those with previous long-term ADT, locally advanced PCa, or any PSA-influencing therapy were excluded. All patients were treated completely by Ablatherm® HIFU device. Evaluation was performed in aggregate and by stratification according to cohort group, risk group (D'Amico criteria), PSA Nadir, and Gleason score. Phoenix definition was used for biochemical failure. Statistical analysis was performed using the Kaplan-Meier method, univariate and multivariate analysis employing a Cox model.
RESULTS: Of 704 study patients, 78.5% had intermediate- or high-risk disease. Mean follow-up was 5.3 (1.3-14) years. Cancer-specific survival was 99%, metastasis-free survival 95%, and 10-year salvage treatment-free rates were 98% in low-risk, 72% in intermediate-risk, and 68% in high-risk patients. PSA Nadir and Gleason score predicted biochemical failure, side effects showed to be moderate. HIFU retreatment rate was 15% since 2005.
CONCLUSIONS: Long-term follow-up with HIFU therapy showed a high overall rate of cancer-specific survival and an exceptionally high rate of freedom from salvage therapy requirement in low-risk patients. Advances in HIFU technology and clinical practice and the use of neoadjuvant TURP allow complete treatment of any sized prostate without induction of metastasis.
Written by:
Thüroff S, Chaussy C. Are you the author?
Harlachinger Krebshilfe e.V., Munich, Germany; Department of Urology, Klinikum Harlaching, Munich, Germany.
Reference: J Urol. 2013 Feb 12. pii: S0022-5347(13)00277-2.
doi: 10.1016/j.juro.2013.02.010
PubMed Abstract
PMID: 23415962
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