Fourteen‐year oncological and functional outcomes of high‐intensity focused ultrasound in localized prostate cancer. (28th January 2013)

• Record Type: Journal Article
• Authors: Ganzer, Roman; Fritsche, Hans‐Martin; Brandtner, Andreas; Bründl, Johannes; Koch, Daniel; Wieland, Wolf F.; Blana, Andreas
• Is Part Of: BJU international. Volume 112:Number 3(2013:Aug.)
• Page Start: 322
• Page End: 329
• Publication Date: 2013-01-28
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11715.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11715-sec-0001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11715-list-0001" list-type="bullet"> <list-item> <p>High‐intensity focused ultrasound (HIFU) is an alternative treatment option for localized prostate cancer (PCa), which is applied for over 15 years. There are conflicting recommendations for HIFU among urological societies, which can be explained by the lack of prospective controlled studies, reports on preselected patient populations and limited follow‐up providing little information on overall and cancer‐specific survival.</p> </list-item> <list-item> <p>We report on a large, unselected consecutive patient series of patients who have undergone primary HIFU for clinically localized PCa with the longest follow‐up in current literature. Our results improve the understanding of the oncological efficacy, morbidity and side effects of primary HIFU.</p> </list-item> </list> </p> </sec> <sec id="bju11715-sec-0002" sec-type="section"> <title>Objective</title> <p> <list id="bju11715-list-0002" list-type="bullet"> <list-item> <p>To assess the safety, functional and oncological long‐term outcomes of high‐intensity focused ultrasound (HIFU) as a primary treatment option for localized prostate cancer (PCa).</p> </list-item> </list> </p> </sec> <sec id="bju11715-sec-0003" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju11715-list-0003" list-type="bullet"> <list-item> <p>We conducted a retrospective single‐centre study on 538 consecutive patients who underwent primary HIFU for clinically localized PCa between November 1997 and September 2009.</p> </list-item> <list-item> <p>Factors assessed were: biochemical disease‐free survival (BDFS) according to Phoenix criteria (prostate‐specific antigen nadir + 2 ng/mL); metastatic‐free, overall and PCa‐specific survival; salvage treatment; side effects; potency; and continence status.</p> </list-item> </list> </p> </sec> <sec id="bju11715-sec-0004" sec-type="section"> <title>Results</title> <p> <list id="bju11715-list-0004" list-type="bullet"> <list-item> <p>The mean (<sc>sd</sc>; range) follow‐up was 8.1 (2.9; 2.1–14.0) years.</p> </list-item> <list-item> <p>The actuarial BDFS rates at 5 and 10 years were 81 and 61%, respectively. The 5‐year BDFS rates for low‐, intermediate‐ and high‐risk patients were 88, 83 and 48%, while the 10‐year BDFS rates were 71, 63 and 32%, respectively.</p> </list-item> <list-item> <p>Metastatic disease was reported in 0.4, 5.7 and 15.4% of low‐, intermediate‐ and high‐risk patients, respectively.</p> </list-item> <list-item> <p>The salvage treatment rate was 18%.</p> </list-item> <list-item> <p>Seventy‐five (13.9%) patients died. PCa‐specific death was registered in 18 (3.3%) patients (0, 3.8 and 11% in the low‐, intermediate‐ and high‐risk groups, respectively).</p> </list-item> <list-item> <p>Side effects included bladder outlet obstruction (28.3%), Grade I, II and III stress urinary incontinence (13.8, 2.4 and 0.7%, respectively) and recto‐urethral fistula (0.7%). Preserved potency was 25.4% (in previously potent patients).</p> </list-item> </list> </p> </sec> <sec id="bju11715-sec-0005" sec-type="section"> <title>Conclusions</title> <p> <list id="bju11715-list-0005" list-type="bullet"> <list-item> <p>The study demonstrates the efficacy and safety of HIFU for localized PCa.</p> </list-item> <list-item> <p>HIFU is a therapeutic option for patients of advanced age, in the low‐ or intermediate‐risk groups, and with a life expectancy of ∼10 years.</p> </list-item> </list> </p> </sec> </abstract>