Transrectal High Intensity Focused Ultrasound In The Treatment Of Localized Prostate Cancer - The First UK Series

Main Category: Prostate / Prostate Cancer
Also Included In: Cancer / Oncology;  Urology / Nephrology
Article Date: 24 Jun 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - The use of HIFU in localized prostate cancer (PCa) is an emerging minimally-invasive technology that offers the potential fewer side-effects and effective cancer control. Visually-directed HIFU for the conduct of therapy for the Sonablate®500 device allows the user to change energy levels per pulse based on real-time greyscale ultrasound feedback.

A group of investigators from the UK studied all 172 primary HIFU cases with presumed organ-confined disease treated between February 2005 and 15th May 2007. An analysis of side-effects, PSA kinetics and early cancer control was carried out.

The mean age was 64.1 years (SD 8.3) with a mean follow-up of 346 days (SD 237, max 759). 27.8% (38/136), 37.5% (51/136) and 34.6% (47/136) were in the low, intermediate and high risk categories. 29% (50/172) were on 3 months casodex 50mg to cytoreduce gland size. Median hospital stay was 5 hours and 22% required an overnight stay. Urinary tract infection/dysuria syndrome occurred in 23.54% and urethral stricture in 36% overall. There was a significant reduction in stricture rate using a suprapubic catheter (14.6%) compared to urethral catheter (44%) (p=0.001). Mild-moderate stress urinary incontinence occurred in 7.6% (13/172). PSA levels below 0.2ng/ml for those who reached 3, 6, 9, 12, 18 and 24 months were achieved by 69.7% (108/155), 65% (78/120), 58% (60/103), 57.8% (48/83), 57% (36/63) and 60.9% (14/23), respectively. 83.2%, 78.3%, 80.58%, 78.31%, 74.6%, and 82.61% achieved <0.5ng.ml. 31 demonstrated a clinically concerning PSA level or a rising PSA and had biopsy. 13 had positive biopsies and 4 were treated by redo HIFU. 92.1%, 90.2% and 91.5% of patients had no evidence of disease in the low, intermediate and high risk groups. Overall, 92.4% demonstrated no evidence of disease.

They concluded that HIFU for localized prostate cancer is a safe, day case procedure with toxicity that is lower than other radical treatments. Success of various modalities of localized prostate cancer therapy has been difficult to define and they report their PSA kinetics using 0.2ng/ml and 0.5ng/ml to inform comparison with other studies. If the procedure is standardized, good early biochemical control can be achieved.

Presented by Evangelos Zacharakis, MD, Hashim U Ahmed, MD, Tim Dudderidge, MD, Rebecca Scott, MD, James Armitage, MD, Rowland O Illing, MD, Clare Allen, MD, Mark Emberton, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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