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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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Contrast enhanced MRI changes in an under-treated prostate following HIFU. (A) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium prior to HIFU treatment demonstrating localised disease with a lesion in the left postero-lateral side of the gland (circled). (B) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium at 2 weeks demonstrating poor perfusion in the posterior prostate after HIFU treatment but an area of residual tissue with enhancement anteriorly (circled). (C) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium at 6 months showing residual prostate tissue (circled).
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fig7: Contrast enhanced MRI changes in an under-treated prostate following HIFU. (A) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium prior to HIFU treatment demonstrating localised disease with a lesion in the left postero-lateral side of the gland (circled). (B) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium at 2 weeks demonstrating poor perfusion in the posterior prostate after HIFU treatment but an area of residual tissue with enhancement anteriorly (circled). (C) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium at 6 months showing residual prostate tissue (circled).

Mentions: Not all men accepted post-HIFU biopsies, because those in whom the PSA was >0.5 ng ml−1 but stable did not wish to have biopsies. Therefore, 31 patients were biopsied. 13 had proven histological evidence of either residual or recurrent cancer. The histology demonstrated Gleason score 7 in 5 out of 13 and Gleason score 6 in 7 out of 13 (ungradeable in 1 out of 13). Of the 13 with histological evidence of recurrent/residual cancer, eight opted for re-treatment with HIFU. Of these, three out of eight had biochemical control at 6–12 months (PSA <0.2 ng ml−1 in two out of eight and <0.5 ng ml−1 in one out of eight), one out of eight failed again (positive on biopsy) and underwent salvage external beam radiotherapy and four out of eight had insufficient follow-up to make meaningful comments about PSA kinetics (<6 months). The remainder who had positive biopsies (5 out of 13) opted for active surveillance of low volume, Gleason 3+3 residual prostate cancer. Figure 6A–C show a series of MRI scans demonstrating the ablation that is possible in a successful HIFU treatment whereas Figure 7A–C demonstrate incomplete ablation.


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)

Contrast enhanced MRI changes in an under-treated prostate following HIFU. (A) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium prior to HIFU treatment demonstrating localised disease with a lesion in the left postero-lateral side of the gland (circled). (B) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium at 2 weeks demonstrating poor perfusion in the posterior prostate after HIFU treatment but an area of residual tissue with enhancement anteriorly (circled). (C) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium at 6 months showing residual prostate tissue (circled).
© Copyright Policy
Related In: Results  -  Collection

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

fig7: Contrast enhanced MRI changes in an under-treated prostate following HIFU. (A) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium prior to HIFU treatment demonstrating localised disease with a lesion in the left postero-lateral side of the gland (circled). (B) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium at 2 weeks demonstrating poor perfusion in the posterior prostate after HIFU treatment but an area of residual tissue with enhancement anteriorly (circled). (C) 1.5 Tesla dynamic contrast enhanced MRI using gadolinium at 6 months showing residual prostate tissue (circled).
Mentions: Not all men accepted post-HIFU biopsies, because those in whom the PSA was >0.5 ng ml−1 but stable did not wish to have biopsies. Therefore, 31 patients were biopsied. 13 had proven histological evidence of either residual or recurrent cancer. The histology demonstrated Gleason score 7 in 5 out of 13 and Gleason score 6 in 7 out of 13 (ungradeable in 1 out of 13). Of the 13 with histological evidence of recurrent/residual cancer, eight opted for re-treatment with HIFU. Of these, three out of eight had biochemical control at 6–12 months (PSA <0.2 ng ml−1 in two out of eight and <0.5 ng ml−1 in one out of eight), one out of eight failed again (positive on biopsy) and underwent salvage external beam radiotherapy and four out of eight had insufficient follow-up to make meaningful comments about PSA kinetics (<6 months). The remainder who had positive biopsies (5 out of 13) opted for active surveillance of low volume, Gleason 3+3 residual prostate cancer. Figure 6A–C show a series of MRI scans demonstrating the ablation that is possible in a successful HIFU treatment whereas Figure 7A–C demonstrate incomplete ablation.

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