Objective: To report on the long‐term results of high‐intensity focused ultrasound in the treatment of localized prostate cancer.
Methods: A total of 517 men with stage T1c–T3N0M0 prostate cancer ...treated with Sonablate devices (Focus Surgery, Indianapolis, IN, USA) between January 1999 and December 2007 were included in the study. Biochemical failure was defined according to the Phoenix definition (prostate‐specific antigen nadir + 2 ng/mL).
Results: The median follow‐up period for all patients was 24.0 months (range, 2 to 88). The biochemical disease‐free rate (BDFR) in all patients at 5 years was 72%. The BDFR in patients with stage T1c, T2a, T2b, T2c and T3 groups at 5 years were 74%, 79%, 72%, 24% and 33%, respectively (P < 0.0001). BDFR in patients in the low, intermediate and high‐risk groups at 5 years were 84%, 64% and 45%, respectively (P < 0.0001). The BDFR in patients treated with or without neoadjuvant hormonal therapy at 7 years were 73% and 53% (P < 0.0001), respectively. In multivariate analysis, pretreatment prostate‐specific antigen levels (hazard ratio 1.060; P < 0.0001; 95% confidence interval 1.040–1.080), neoadjuvant hormonal therapy (hazard ratio 2.252; P < 0.0001; 95% confidence interval 1.530–3.315) and stage (P = 0.0189) were demonstrated to be statistically significant variables. Postoperative erectile dysfunction was noted in 33 out of 114 (28.9%) patients who were preoperatively potent.
Conclusions: High‐intensity focused ultrasound therapy appears to be minimally invasive, efficacious and safe for patients with localized prostate cancer, particularly those with low‐ and intermediate‐risk cancer.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
The purpose of this retrospective study was to compare the toxicity and disease control rate of radiotherapy for prostate cancer in salvage settings after high-intensity focused ultrasound ...(HIFU) therapy (HIFU cohort) with those in radical settings (non-HIFU cohort). From 2012 to 2020, 215 patients were identified for this study and 17 were treated in the salvage settings after HIFU. The median follow-up time was 34.5 months (range: 7–102 months, inter-quartile range IQR: 16–64 months). Genitourinary (GU) and gastrointestinal (GI) adverse events were evaluated in acute and late periods with Common Terminology Criteria for Adverse Events version 5, and the rates of biochemical-clinical failure free survival (BCFS) and overall survival (OS) were estimated. The cumulative incidence of late GU Grade 2 or greater toxicity after five years was significantly different between the non-HIFU and HIFU cohorts with rates of 7.3% and 26.2%, respectively (P = 0.03). Regarding GI Grade 2 or greater toxicity, there was no significant difference between the two cohorts. The 5y-BCFS was 84.2% in the non-HIFU cohort and 69.5% in the HIFU cohort with no significant difference (P = 0.10) and the 5y-OS was 95.9% and 92.3%, respectively (P = 0.47). We concluded that the possibility of increased late GU Grade 2 or greater should be considered when applying salvage radiotherapy for local recurrence after HIFU.
: Recent advances in high‐intensity focused ultrasound, which was developed in the 1940s as a viable thermal tissue ablation approach, have increased its popularity. High‐intensity focused ...ultrasound is currently utilized the most in Europe and Japan, but has not yet been approved by the Food and Drug Administration, USA, for this indication. The purpose of the present report is to review the scientific foundation of high‐intensity focused ultrasound technology and the clinical outcomes achieved with commercially available devices. Recently published articles were reviewed to evaluate the current status of high‐intensity focused ultrasound as a primary or salvage treatment option for localized prostate cancer. Improvements in the clinical outcome as a result of technical, imaging and technological advancements are described herein. A wide range of treatment options for organ‐confined prostate cancer is available. However, high‐intensity focused ultrasound is an attractive choice for men willing to choose less invasive options, although establishing the efficacy of high‐intensity focused ultrasound requires longer follow‐up periods. Technological advances, together with cultural and economic factors, have caused a dramatic shift from traditional open, radical prostatectomy to minimally invasive techniques. High‐intensity focused ultrasound is likely to play a significant role in the future of oncology practice.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Background: High‐intensity focused ultrasound (HIFU) is a minimally invasive technique used in achieve coagulation necrosis. We evaluated biochemical disease‐free survival rates, predictors of ...clinical outcome and morbidity in patients with localized prostate cancer treated with HIFU.
Methods: A total of 181 consecutive patients underwent HIFU with the use of Sonablate (Focus Surgery, Indianapolis, IN, USA). Biochemical recurrence was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology Consensus Panel. The median age and pretreatment prostate‐specific antigen (PSA) level were 70 years (range 44–88) and 9.76 ng/mL (range 3.39–89.60). A total of 95 patients (52%) were treated with neoadjuvant hormones. The median follow‐up period for all patients was 18.0 months (range 4–68).
Results: The biochemical disease‐free survival rates at 1, 3 and 5 years in all patients were 84%, 80% and 78%, respectively. The biochemical disease‐free survival rates at 3 years for patients with pretreatment PSA less than 10 ng/mL, 10.01–20.0 ng/mL and more than 20.0 ng/mL were 94%, 75% and 35%, respectively (P < 0.0001). Multivariate analysis identified pretreatment PSA (P < 0.0001) as a independent predictor of relapse.
Conclusion: High‐intensity focused ultrasound therapy appears to be a safe and efficacious minimally invasive therapy for patients with localized prostate cancer, especially those with a pretreatment PSA level less than 20 ng/mL.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
This study aimed to analyze technical and clinical factors related to oncological outcomes in patients with localized prostate cancer (PC) who were treated with whole-gland high-intensity focused ...ultrasound (HIFU).
From 2007-2014, patients diagnosed with localized PC who underwent whole-gland HIFU were consecutively included retrospectively. Biochemical failure was defined according to the Phoenix ASTRO guidelines. The relationship between oncological outcomes and technical and clinical factors was evaluated.
The study cohort included 428 patients. The median age was 67 years, and the median prostate-specific antigen level was 7.61 ng/mL. Patient risk classifications were low (n = 102), intermediate (n = 240), and high (n = 86). Biochemical disease-free survival rates of patients with HIFU for localized PC in the total, low-, intermediate-, and high-risk groups according to D'Amico risk groups over a median follow-up period of 5 years (range 9-144) were 68.4%, 80.4%, 65.6%, and 61.6%, respectively. In multivariate logistic regression analyses to predict biochemical failure of the treatment, neoadjuvant hormonal therapy (NHT) in the high-risk group (OR 0.225, p = 0.015), and compression method in the low- (OR 0.178, p = 0.030), intermediate- (OR0.291, p < 0.0001), and high-risk (OR 0.316, p = 0.049) groups were significant factors that reduced the risk of biochemical failure after treatment. There were no significant differences in complications between patients treated with compression and those treated conventionally.
NHT may potentially improve oncological outcomes for patients in the high-risk group, and compression methods can improve the oncological outcomes of whole-gland therapy with HIFU.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
To evaluate longitudinal changes in urinary function and quality of life, and the oncological outcomes of patients treated with urethra‐sparing high‐intensity focused ultrasound for ...localized prostate cancer.
Methods
Patients with negative findings in the urethra and the anterior urethral zone using transrectal ultrasound‐guided targeted biopsies, and magnetic resonance imaging, received urethra‐sparing or whole‐gland high‐intensity focused ultrasound as the primary therapy for localized prostate cancer without transurethral resection of the prostate. Longitudinal changes in urinary function and quality of life, and the oncological outcomes of the patients were analyzed retrospectively.
Results
The median follow‐up times for urethra‐sparing and whole‐gland high‐intensity focused ultrasound were 36 and 30 months, respectively. Comparing the patients treated with urethra‐sparing high‐intensity focused ultrasound (n = 45) with those treated with whole‐gland high‐intensity focused ultrasound (n = 65), there were significant differences in the International Prostate Symptom Score (P = 0.014) at 3 months, International Prostate Symptom Score quality of life (P = 0.033) at 3 months, maximum urinary flow rate (mL/s; at 3 months, P = 0.010; at 6 months, P = 0.038) and residual urine volume (mL; at 3 months, P < 0.0001; at 6 months, P = 0.016; at 12 months, P = 0.028). For quality of life, there were significant differences in Functional Assessment of Cancer Therapy – General (at 3 months, P = 0.022) and Functional Assessment of Cancer Therapy – Prostate (at 3 months, P = 0.028; at 6 months, P = 0.034). There were no significant differences in oncological outcomes regarding negative biopsy rates on follow up (91% vs 92%; P = 0.8) or biochemical disease‐free survival rates (86.7% vs 89.2%; P = 0.7).
Conclusions
Urethra‐sparing high‐intensity focused ultrasound might prevent prolonged bladder outlet obstruction, and could be a treatment option for localized prostate cancer.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives: To report our health‐related quality of life (QOL) and functional outcomes following high‐intensity focused ultrasound (HIFU) for localized prostate cancer.
Methods: Data from prostate ...cancer patients undergoing HIFU at our institution between January 1999 and April 2007 were collected in our prospective database. Standard preoperative and surgical parameters, as well as baseline urinary function, QOL and sexual assessment were included. The Japanese version of the Functional Assessment of Cancer Therapy‐general (FACT‐G), the FACT‐prostate (P) and the International Index of Erectile Function‐5 (IIEF‐5) were used for the functional assessment. These self‐administered questionnaires were collected preoperatively and again at 6, 12 and 24 months postoperatively.
Results: A total of 326 patients were included in the analysis. Maximum flow rate and residual urine volume were significantly impaired at 6 months (P = 0.010) after HIFU, even if they returned to baseline values at 12 or 24 months after HIFU. The total FACT‐G score significantly improved at 24 months (P = 0.027) after HIFU. At 6, 12 and 24 months after HIFU, 52%, 63% and 78%, respectively, of the patients, not receiving neoadjuvant hormonal therapy, were potent.
Conclusions: In our experience, functional and QOL outcomes after HIFU therapy for localized prostate cancer are better than those after other treatment modalities.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
To report our early experience with manually controlled targeted biopsy with real‐time multiparametric magnetic resonance imaging and transrectal ultrasound fusion images for the diagnosis ...of prostate cancer.
Methods
A total of 20 consecutive patients suspicious of prostate cancer at the multiparametric magnetic resonance imaging scan were recruited prospectively. Targeted biopsies were carried out for each cancer‐suspicious lesion, and 12 systematic biopsies using the BioJet system. Pathological findings of targeted and systematic biopsies were analyzed.
Results
The median age of the patients was 70 years (range 52–83 years). The median preoperative prostate‐specific antigen value was 7.4 ng/mL (range 3.54–19.9 ng/mL). Median preoperative prostate volume was 38 mL (range 24–68 mL). The number of cancer‐detected cases was 14 (70%). The median Gleason score was 6.5 (range 6–8). Cancer‐detected rates of the systematic and targeted biopsy cores were 6.7 and 31.8%, respectively (P < 0.0001). In six patients who underwent radical prostatectomy, the geographic locations and pathological grades of clinically significant cancers and index lesions corresponded to the pathological results of the targeted biopsies.
Conclusion
Prostate cancers detected by targeted biopsies with manually controlled targeted biopsy using real‐time multiparametric magnetic resonance imaging and transrectal ultrasound fusion imaging have significantly higher grades and longer length compared with those detected by systematic biopsies. Further studies and comparison with the pathological findings of whole‐gland specimens have the potential to determine the role of this biopsy methodology in patients selected for focal therapy and those under active surveillance.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVE
To evaluate the biochemical disease‐free survival (DFS), predictors of clinical outcome and morbidity of patients with localized prostate cancer treated with high‐intensity focused ...ultrasound (HIFU), a noninvasive treatment that induces complete coagulative necrosis of a tumour at depth through the intact skin.
PATIENTS AND METHODS
In all, 63 patients with stage T1c‐2bN0M0 localized prostate cancer underwent HIFU using the SonablateTM system (Focus Surgery, Inc., Indianapolis, IN, USA). None of the patients received neoadjuvant and/or adjuvant therapy. Biochemical recurrence was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology consensus definition, i.e. three consecutive increases in prostate‐specific antigen (PSA) level after the nadir. The median (range) age, PSA level and follow‐up were 71 (45–87) years, 8.5 (3.39–57.0) ng/mL and 22.0 (3–63) months, respectively.
RESULTS
The overall biochemical disease‐free rate was 75% (47 patients). The 3‐year biochemical DFS rates for patients with a PSA level before HIFU of <10, 10.01–20 and >20 ng/mL were 82%, 62% and 20% (P < 0.001), respectively. The 3‐year biochemical DFS rates for patients with a PSA nadir of <0.2, 0.21–1 and >1 ng/mL were 100%, 74% and 21% (P < 0.001), respectively. Final follow‐up sextant biopsies showed that 55 (87%) of the patients were cancer‐free. Multivariate analysis showed that the PSA nadir (P < 0.001) was a significant independent predictor of relapse.
CONCLUSION
HIFU therapy appears to be a safe, effective and minimally invasive therapy for patients with localized prostate cancer, and the PSA nadir is a useful predictor of clinical outcome.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
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