Abstract Objective To evaluate the long-term efficacy of high-intensity focused ultrasound (HIFU) therapy for patients with localised prostate cancer. Material and methods Patients included in this ...multicentre analysis had T1–T2 NxM0 prostate cancer, a PSA < 15 ng/ml, and a Gleason score (GS) ≤ 7, and were treated with prototypes or first-generation Ablatherm™ HIFU devices between October 1997 and August 2001. The Phoenix definition of biochemical failure was used (PSA nadir + 2). Treatment failure was defined as: biochemical failure or positive biopsy. Results A total of 140 patients with a mean (SD) age 69.1 yr (6.6) were included. Mean (SD) follow-up was 6.4 yr (1.1). Control prostate biopsies were negative in 86.4% of patients. Median PSA nadir of 0.16 ng/ml (range, 0.0–9.1) was achieved at a mean (SD) of 4.9 mo (5.2). A PSA nadir ≤ 0.5 ng/ml was recorded in 68.4% of patients. The actuarial biochemical failure–free survival rates (SR) at 5 and 7 yr were 77% and 69%, respectively. The actuarial disease–free SR at 5 and 7 yr were 66% and 59%, respectively. Conclusions This study demonstrates the effective long-term cancer control achieved with HIFU in patients with low- or intermediate-risk localised prostate cancer.
Objective
To report the oncological outcome of salvage high‐intensity focused ultrasound (S‐HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre ...database.
Patients and Methods
This retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S‐HIFU from 1995 to 2009. The biochemical failure‐free survival (bFFS) rate was based on the ‘Phoenix’ definition (PSA nadir + 2 ng/mL). Secondary endpoints included progression to metastasis and cancer‐specific death. Kaplan–Meier analysis was performed examining overall (OS), cancer‐specific (CSS) and metastasis‐free survival (MFS). Adverse events and quality of life status are reported.
Results
In all, 418 patients with a mean (SD) follow‐up of 3.5 (2.5) years were included. The mean (SD) age was 68.6 (5.8) years and the PSA level before S‐HIFU was 6.8 (7.8) ng/mL. The median PSA nadir after S‐HIFU was 0.19 ng/mL. The OS, CSS and MFS rates at 7 years were 72%, 82% and 81%, respectively. At 5 years the bFFS rate was 58%, 51% and 36% for pre‐EBRT low‐, intermediate‐ and high‐risk patients, respectively. The 5‐year bFFS rate was 67%, 42% and 22% for pre‐S‐HIFU PSA level ≤4, 4–10 and ≥10 ng/mL, respectively. Complication rates decreased after the introduction of specific post‐RT parameters: incontinence (grade II or III) from 32% to 19% (P = 0.002); bladder outlet obstruction or stenosis from 30% to 15% (P = 0.003); recto‐urethral fistula decreased from 9% to 0.6% (P < 0.001). Study limitations include being a retrospective analysis from a registry with no control group.
Conclusion
S‐HIFU for locally recurrent prostate cancer after failed EBRT is associated with 7‐year CSS and MFS rates of >80% at a price of significant morbidity. S‐HIFU should be initiated early following EBRT failure
Objectives To report on the long-term results of high-intensity focused ultrasonography (HIFU) in the treatment of localized prostate cancer. Methods Patients with clinical Stage T1-T2N0M0, ...biopsy-proven, localized prostate cancer, with a serum prostate-specific antigen (PSA) level of ≤20 ng/mL, Gleason score of ≤7, and with no previous curative prostate cancer treatment, were included. All patients underwent HIFU using the Ablatherm device and were required to have a minimal follow-up of 3 years after the last HIFU session to be included in this analysis. Follow-up included PSA measurement and biopsy performed 3-6 months after treatment and in conjunction with an increasing PSA level. Biochemical failure was defined according to the Phoenix definition (PSA nadir + 2 ng/mL). In determining the disease-free survival rate, treatment was considered to have failed if any of the following occurred: biochemical failure, positive biopsy findings, or the initiation of salvage treatment. Results The study included 163 patients. Within the 4.8 ± 1.2 years of follow-up, no patient died of prostate cancer. Of the 163 patients, 86.4% achieved a PSA nadir of <1 ng/mL and 92.7% had negative post-treatment biopsy findings. The actuarial biochemical survival rate at 5 years was 75%. The actuarial disease-free survival rate at 5 years was 66%, with salvage treatment initiated for 12% of the patients. On multivariate analysis, the pretreatment PSA level was the only statistically significant predictive factor of recurrence ( P = .005). Conclusions The results after long-term follow-up have indicated that HIFU is an efficient and safe treatment for patients with localized prostate cancer.
Purpose
The extent of variation in urinary and sexual functional outcomes after radical prostatectomy (RPE) between prostate cancer (PC) operating sites remains unknown. Therefore, this analysis aims ...to compare casemix-adjusted functional outcomes (EPIC-26 scores incontinence, irritative/obstructive function and sexual function) between operating sites 12 months after RPE.
Materials and methods
Analysis of a cohort of 7065 men treated with RPE at 88 operating sites (prostate cancer centers, “PCCs”) between 2016 and 2019. Patients completed EPIC-26 and sociodemographic information surveys at baseline and 12 months after RPE. Survey data were linked to clinical data. EPIC-26 domain scores at 12 months after RPE were adjusted for relevant confounders (including baseline domain score, clinical and sociodemographic information) using regression analysis. Differences between sites were described using minimal important differences (MIDs) and interquartile ranges (IQR). The effects of casemix adjustment on the score results were described using Cohen’s
d
and MIDs.
Results
Adjusted domain scores at 12 months varied between sites, with IQRs of 66–78 (incontinence), 89–92 (irritative/obstructive function), and 20–29 (sexual function). Changes in domain scores after casemix adjustment for sites ≥ 1 MID were noted for the incontinence domain (six sites). Cohen’s
d
ranged between − 0.07 (incontinence) and − 0.2 (sexual function), indicating a small to medium effect of casemix adjustment.
Conclusions
Variation between sites was greatest in the incontinence and sexual function domains for RPE patients. Future research will need to identify the factors contributing to this variation.
Trial Registry.
The study is registered at the German Clinical Trial Registry (
https://www.drks.de/drks_web/
) with the following ID: DRKS00010774.
Abstract Background The exact distribution of periprostatic autonomic nerves is under debate. Objective To study the topographical anatomy of autonomic nerves of the periprostatic tissue and the ...capsule of the prostate (CAP). Design, Setting, and Participants Whole-mount sections of 30 prostates from patients having undergone non–nerve-sparing radical prostatectomy were investigated after immunohistochemical nerve staining. Sections from the base, the middle, and the apex were evaluated. All sections were divided into 12 sectors, which were combined into the following regions: ventral, ventrolateral, dorsolateral, and dorsal. Measurements Quantification of periprostatic and capsular nerves was performed within the sectors. Computerised planimetry of the total periprostatic nerve surface area of each region was performed (Image-J software, Wayne Rasband, National Institute of Health, USA). Results and Limitations A total of 3514, 3860, and 3902 periprostatic nerves was counted at the base, the middle, and the apex, respectively ( p = 0.068). The ratio of periprostatic nerves to capsular nerves was 3.6, 2.1, and 1.9 at the base, the middle, and the apex, respectively ( p = 0.004). Computerised planimetry revealed a significant decrease in total nerve surface area from the base over the middle towards the apex, with 241.79, 133.64, and 89.50 mm2 ( p = 0.004). The percentage of total nerve surface area was highest dorsolaterally (84.1%, 75.1%, and 74.5% at base, middle, and apex, respectively) but variable: Up to 39.9% of nerve surface area was found ventrolaterally and up to 45.5% in the dorsal position. The study is limited by the fact that autonomic nerve distribution was only investigated from the base to the apex of the prostate. Conclusions Periprostatic nerve distribution is variable, with a high percentage of nerves in the ventrolateral and dorsal positions. Total periprostatic nerve surface area decreases from the base towards the apex due to nerves leaving the NVB branching into the prostate. This can only be discovered by nerve planimetry, not by quantification.
Wolfgang Otto1, Maximilian Burger1, Hans-Martin Fritsche1, Andreas Blana1, Wolfgang Roessler1, Ruth Knuechel2, Wolf F. Wieland1 and Stefan Denzinger11Department of Urology, University of Regensburg, ...Germany. 2Institute of Pathology, RWTH Aachen, Germany.AbstractObjective: Photodynamic diagnosis (PDD) of superficial bladder cancer decreases recurrence rates. We present oncological results of a randomized, prospective study, comparing transurethral resection (TUR) performed under conventional white light (WL) with PDD. The follow-up period is the longest reported to date. As costs might be reimbursed by prolonged recurrence-free survival in certain patients cost analysis in regard to risk-groups was performed.Material and methods: Using chi-square test and log-rank test we compared recurrence rates of 103 patients after WL-TUR and of 88 patients after PDD-TUR. Cost analysis was performed according to risk-groups of recurrence.Results: Mean follow-up was 99 months. Recurrence rate was 57% in WL vs. 28% in PDD (p 0.001). Costs incurred by subsequent TUR averaged € 2310 per WL patient vs. € 713 per PDD patient. Savings per patient by PDD amounted to € 1597. PDD costs were reimbursed in low, intermediate and high risk patients, respectively.Conclusions: PDD-TUR is significantly superior to conventional WL-TUR in terms of recurrence rate. While economic benefit is most prominent in intermediate risk patients, PDD related costs are reimbursed in all risk-groups.
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