Eight Years' Experience With High-Intensity Focused Ultrasonography For Treatment Of Localized Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 10 Nov 2008 - 4:00 PDT

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BERKELEY, CA (UroToday.com) - High-intensity focused ultrasonography (HIFU) is an approach to the treatment of prostate cancer (CaP). While not FDA approved in the US, it is approved and gaining popularity in many countries. HIFU utilizes acoustic energy delivered from a transducer, resulting in tissue destruction in the path of the ultrasound beam. In the online edition of Urology, a team of German physicians headed by Dr. Andreas Blana reported 8-year outcomes using HIFU.

From 1997 to 2003, 163 men with localized CaP were treated with HIFU, using the ABLATHERM® device. The procedures were performed under spinal anesthesia, with a suprapubic tube placement. Between 1 and 4 overlapping target areas were defined and treated. Beginning in 2000, transurethral resection of the prostate (TURP) was performed immediately before HIFU to reduce the risk of urinary retention. Some patients were treated with androgen deprivation therapy (ADT) for 3 months prior to HIFU. Patients were assessed for biochemical failure by the Phoenix definition of PSA nadir + 2ng/ml.

Mean patient follow-up was 4.8 years. Forty-seven patients treated between 1997 and 1999 received HIFU alone. Those treated between 2000 - 2003 (116 patients) received TURP plus HIFU. Of the 116 TURP specimens, 56% exhibited tumors on pathologic examination. The average number of HIFU sessions was 1.2 per patient. Using calculations to assess the degree of HIFU overlap, 173% of the prostate volumes were treated by overlapping treatment areas.

Androgen deprivation therapy (ADT) was given to 60 patients prior to HIFU, and due to potential effects on PSA, these 60 were excluded from the PSA nadir analysis. The remaining 103 patients reached a nadir within 6 months of HIFU; 64% reaching a nadir (or <0.02ng/ml), 18.5% a nadir of 0.21-0.1ng/ml, and 14% a nadir >1ng/ml. Among the 5 deaths that occurred during follow-up, none were from CaP.

Upon follow-up prostate biopsy performed in 124 patients, 115 (92.7%) showed no evidence of viable CaP. This outcome was similar among low and intermediate risk patients. Salvage treatment was given to 20 men: 8 received androgen deprivation, 10 radiotherapy and 2 salvage prostatectomy. Actuarial biochemical disease free survival at 5 years was 75%, and actuarial disease free survival at 5 years was 66%. TURP had no impact on outcome, and pretreatment PSA levels were the only statistically significant predictive factors. Grade 1 incontinence was reported in 6.1% of patients; grade 2 in 1.8% and no patients had grade 3 incontinence. Among 127 patients with evaluable erectile dysfunction data, 76 were potent prior to HIFU, and 42 had full erectile function after HIFU. Thirty-four were impotent. Forty men (24.5%) developed obstruction and required transurethral surgical intervention. This did not differ between those who had HIFU only or those who had HIFU and TURP.

The authors concluded, after long-term follow-up, that the results have indicated HIFU to be an efficient and safe treatment for patients with localized prostate cancer.

Blana A, Rogenhofer S, Ganzer R, Lunz JC, Schostak M, Wieland WF, Walter B
Urology. 2008 Sep 29. Epub ahead of print.
doi:10.1016/j.urology.2008.06.062

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

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