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High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series.

Ahmed HU, Zacharakis E, Dudderidge T, Armitage JN, Scott R, Calleary J, Illing R, Kirkham A, Freeman A, Ogden C, Allen C, Emberton M - Br. J. Cancer (2009)

Bottom Line: Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated.Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P=0.005).In all, 78.3% achieved a PSA nadir < or =0.5 microg ml(-1) at 12 months, with 57.8% achieving < or =0.2 microg ml(-1).

View Article: PubMed Central - PubMed

Affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK. hashim.ahmed@ucl.ac.uk

ABSTRACT

Background: The use of minimally invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy.

Methods: An analysis of men with organ-confined prostate cancer treated with transrectal whole-gland HIFU (Sonablate 500) between 1 February 2005 and 15 May 2007 was carried out in two centres. Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated.

Results: A total of 172 men were treated under general anaesthetic as day-case procedures with 78% discharged a mean 5 h after treatment. Mean follow-up was 346 days (range 135-759 days). Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P=0.005). Antibiotics were given to 23.8% of patients for presumed urinary tract infection and the rate of epididymitis was 7.6%. Potency was maintained in 70% by 12 months, whereas mild stress urinary incontinence (no pads) was reported in 7.0% (12 out of 172) with a further 0.6% (1 out of 172) requiring pads. There was no rectal toxicity and no recto-urethral fistulae. In all, 78.3% achieved a PSA nadir < or =0.5 microg ml(-1) at 12 months, with 57.8% achieving < or =0.2 microg ml(-1). Then, 8 out of 13 were retreated with HIFU, one had salvage external beam radiotherapy and four chose active surveillance for small-volume low-risk disease. Overall, there was no evidence of disease (PSA <0.5 microg ml(-1) or negative biopsy if nadir not achieved) after one HIFU session in 92.4% (159 out of 172) of patients.

Conclusion: HIFU is a minimally invasive, day-case ablative technique that can achieve good biochemical outcomes in the short term with minimal urinary incontinence and acceptable levels of erectile dysfunction. Long-term outcome needs further evaluation and the inception of an international registry for cases treated using HIFU will significantly aid this health technology assessment.

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Related in: MedlinePlus

Kaplan Meier curve demonstrating the effect of hormone used as cytoreduction prior to HIFU (PSA </=0.5 ng/ml).
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fig5: Kaplan Meier curve demonstrating the effect of hormone used as cytoreduction prior to HIFU (PSA </=0.5 ng/ml).

Mentions: Figure 1 illustrates the PSA changes that occurred over the period of follow-up with mean PSA levels at baseline, 3, 6, 9, 12, 18, and 24 months of 8.3 ng ml−1 (range 7.01–9.41), 0.33 (range 0.22–0.45), 0.49 (range 0.28–0.69), 0.54 (range 0.26–0.82), 0.65 (range 0.27–1.02), 0.68 (range 0.39–0.97) and 0.57 (range 0.12–1.02). The proportion achieving PSA levels ⩽0.2 ng ml−1 for those who completed 3, 6, 9, 12, 18, and 24 months was 70, 65, 58, 58, 57, and 60.9%, respectively (Table 3) (Figure 2). We found no significant relationship between Gleason score, preoperative PSA, or T-stage and the ability to render a PSA nadir ⩽0.2 ng ml−1 (univariate analysis). In comparison 83, 78, 81, 78, 75, and 83% of men achieved ⩽0.5 ng ml−1, at 3, 6, 9, 12, 18, and 24 months, respectively (Figure 3). We analysed the effect of hormonal use on the ability to achieve a PSA nadir <0.2 and <0.5 ng ml−1 with the use of Kaplan–Meier curves. There was no statistically significant difference between the group on hormones and those without (Breslow (Generalised Wilcoxon) P=0.693 for PSA 0.2 ng ml−1 and P=0.146 for PSA 0.5 ng ml−1) (Figures 4 and 5). Of those achieving unrecordable PSA levels at 3 months follow-up, 23 out of 64 had hormones and 41 out of 64 had no hormones.


High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series.

Ahmed HU, Zacharakis E, Dudderidge T, Armitage JN, Scott R, Calleary J, Illing R, Kirkham A, Freeman A, Ogden C, Allen C, Emberton M - Br. J. Cancer (2009)

Kaplan Meier curve demonstrating the effect of hormone used as cytoreduction prior to HIFU (PSA </=0.5 ng/ml).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2713711&req=5

fig5: Kaplan Meier curve demonstrating the effect of hormone used as cytoreduction prior to HIFU (PSA </=0.5 ng/ml).
Mentions: Figure 1 illustrates the PSA changes that occurred over the period of follow-up with mean PSA levels at baseline, 3, 6, 9, 12, 18, and 24 months of 8.3 ng ml−1 (range 7.01–9.41), 0.33 (range 0.22–0.45), 0.49 (range 0.28–0.69), 0.54 (range 0.26–0.82), 0.65 (range 0.27–1.02), 0.68 (range 0.39–0.97) and 0.57 (range 0.12–1.02). The proportion achieving PSA levels ⩽0.2 ng ml−1 for those who completed 3, 6, 9, 12, 18, and 24 months was 70, 65, 58, 58, 57, and 60.9%, respectively (Table 3) (Figure 2). We found no significant relationship between Gleason score, preoperative PSA, or T-stage and the ability to render a PSA nadir ⩽0.2 ng ml−1 (univariate analysis). In comparison 83, 78, 81, 78, 75, and 83% of men achieved ⩽0.5 ng ml−1, at 3, 6, 9, 12, 18, and 24 months, respectively (Figure 3). We analysed the effect of hormonal use on the ability to achieve a PSA nadir <0.2 and <0.5 ng ml−1 with the use of Kaplan–Meier curves. There was no statistically significant difference between the group on hormones and those without (Breslow (Generalised Wilcoxon) P=0.693 for PSA 0.2 ng ml−1 and P=0.146 for PSA 0.5 ng ml−1) (Figures 4 and 5). Of those achieving unrecordable PSA levels at 3 months follow-up, 23 out of 64 had hormones and 41 out of 64 had no hormones.

Bottom Line: Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated.Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P=0.005).In all, 78.3% achieved a PSA nadir < or =0.5 microg ml(-1) at 12 months, with 57.8% achieving < or =0.2 microg ml(-1).

View Article: PubMed Central - PubMed

Affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK. hashim.ahmed@ucl.ac.uk

ABSTRACT

Background: The use of minimally invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy.

Methods: An analysis of men with organ-confined prostate cancer treated with transrectal whole-gland HIFU (Sonablate 500) between 1 February 2005 and 15 May 2007 was carried out in two centres. Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated.

Results: A total of 172 men were treated under general anaesthetic as day-case procedures with 78% discharged a mean 5 h after treatment. Mean follow-up was 346 days (range 135-759 days). Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P=0.005). Antibiotics were given to 23.8% of patients for presumed urinary tract infection and the rate of epididymitis was 7.6%. Potency was maintained in 70% by 12 months, whereas mild stress urinary incontinence (no pads) was reported in 7.0% (12 out of 172) with a further 0.6% (1 out of 172) requiring pads. There was no rectal toxicity and no recto-urethral fistulae. In all, 78.3% achieved a PSA nadir < or =0.5 microg ml(-1) at 12 months, with 57.8% achieving < or =0.2 microg ml(-1). Then, 8 out of 13 were retreated with HIFU, one had salvage external beam radiotherapy and four chose active surveillance for small-volume low-risk disease. Overall, there was no evidence of disease (PSA <0.5 microg ml(-1) or negative biopsy if nadir not achieved) after one HIFU session in 92.4% (159 out of 172) of patients.

Conclusion: HIFU is a minimally invasive, day-case ablative technique that can achieve good biochemical outcomes in the short term with minimal urinary incontinence and acceptable levels of erectile dysfunction. Long-term outcome needs further evaluation and the inception of an international registry for cases treated using HIFU will significantly aid this health technology assessment.

Show MeSH
Related in: MedlinePlus