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High Intensity Focused Ultrasound versus Brachytherapy for the Treatment of Localized Prostate Cancer: A Matched-Pair Analysis.

Aoun F, Limani K, Peltier A, Marcelis Q, Zanaty M, Chamoun A, Vanden Bossche M, Roumeguère T, van Velthoven R - Adv Urol (2015)

Bottom Line: Results.Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p < 0.05).Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, 1000 Brussels, Belgium.

ABSTRACT
Purpose. To evaluate postoperative morbidity and long term oncologic and functional outcomes of high intensity focused ultrasound (HIFU) compared to brachytherapy for the treatment of localized prostate cancer. Material and Methods. Patients treated by brachytherapy were matched 1 : 1 with patients who underwent HIFU. Differences in postoperative complications across the two groups were assessed using Wilcoxon's rank-sum or χ (2) test. Kaplan-Meier curves, log-rank tests, and Cox regression models were constructed to assess differences in survival rates between the two groups. Results. Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p < 0.05). Median oncologic follow-up was 83 months (13-123 months) in the HIFU cohort and 44 months (13-89 months) in the brachytherapy cohort. Median time to achieve PSA nadir was statistically shorter in the HIFU. Biochemical recurrence-free survival rate was significantly higher in the brachytherapy cohort compared to HIFU cohort (68.5% versus 53%, p < 0.05). No statistically significant difference in metastasis-free, cancer specific, and overall survivals was observed between the two groups. Conclusion. HIFU and brachytherapy are safe with no significant difference in cancer specific survival on long term oncologic follow-up. Nonetheless, a randomized controlled trial is needed to confirm these results.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curves for biochemical recurrence-free survival using Stuttgart (a) and Phoenix (b) definitions stratified according to D'Amico risk classification.
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fig2: Kaplan-Meier curves for biochemical recurrence-free survival using Stuttgart (a) and Phoenix (b) definitions stratified according to D'Amico risk classification.

Mentions: During the period of the study, 106 patients underwent LDR brachytherapy. Patients with incomplete oncologic data (4 patients) or limited follow-up < 12 months (32 patients) were excluded. A total of 70 patients have been included in the final analysis. These patients were matched with an equal number of patients treated by whole gland HIFU during the same years. Matching was successful with no statistically significant difference across the two groups except for the age (Table 1); patients operated by HIFU were older than patients undergoing brachytherapy (p < 0.01). The overall clinical and pathologic characteristics of the entire prospective HIFU cohort from which patients were selected for matching can be observed in Table 2. Median oncologic follow-up was statistically higher for the HIFU cohort compared to the brachytherapy cohort (83 months versus 44 months, p < 0.01). PSA nadir was noted in 95.7% of patients after HIFU and in 94.3% of patients after brachytherapy (Figure 1). The median time to achieve the nadir was statistically shorter in the HIFU cohort compared to the brachytherapy cohort (3 months versus 25 months, p < 0.05). Oncologic outcomes of the two cohorts are summarized in Table 3. The Phoenix and Stuttgart definitions were used for biochemical recurrence. Hazards ratio was calculated using HIFU cohort as a reference. The 5-year actuarial BRFS rates were significantly higher for the brachytherapy cohort compared to the HIFU cohort according to the Phoenix (68.5% versus 53%, HR = 0.41; CI 95%: 0.19–0.81, p < 0.05) and Stuttgart definitions (60.9% versus 53%, HR = 0.39; CI 95%: 0.19–0.74, p < 0.05), respectively. When stratifying patients according to the D'Amico risk and the technique used, BRFS rates were significantly higher for the low risk group treated by brachytherapy compared to the low risk group treated by HIFU according to Phoenix (77.5% versus 68%, HR = 0.31; CI 95%: 0.09–0.94, p = 0.05) and Stuttgart definitions (77.5% versus 56.3%, HR = 0.31; CI 95%: 0.10–0.84, p = 0.03), respectively (Figure 2).


High Intensity Focused Ultrasound versus Brachytherapy for the Treatment of Localized Prostate Cancer: A Matched-Pair Analysis.

Aoun F, Limani K, Peltier A, Marcelis Q, Zanaty M, Chamoun A, Vanden Bossche M, Roumeguère T, van Velthoven R - Adv Urol (2015)

Kaplan-Meier curves for biochemical recurrence-free survival using Stuttgart (a) and Phoenix (b) definitions stratified according to D'Amico risk classification.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556829&req=5

fig2: Kaplan-Meier curves for biochemical recurrence-free survival using Stuttgart (a) and Phoenix (b) definitions stratified according to D'Amico risk classification.
Mentions: During the period of the study, 106 patients underwent LDR brachytherapy. Patients with incomplete oncologic data (4 patients) or limited follow-up < 12 months (32 patients) were excluded. A total of 70 patients have been included in the final analysis. These patients were matched with an equal number of patients treated by whole gland HIFU during the same years. Matching was successful with no statistically significant difference across the two groups except for the age (Table 1); patients operated by HIFU were older than patients undergoing brachytherapy (p < 0.01). The overall clinical and pathologic characteristics of the entire prospective HIFU cohort from which patients were selected for matching can be observed in Table 2. Median oncologic follow-up was statistically higher for the HIFU cohort compared to the brachytherapy cohort (83 months versus 44 months, p < 0.01). PSA nadir was noted in 95.7% of patients after HIFU and in 94.3% of patients after brachytherapy (Figure 1). The median time to achieve the nadir was statistically shorter in the HIFU cohort compared to the brachytherapy cohort (3 months versus 25 months, p < 0.05). Oncologic outcomes of the two cohorts are summarized in Table 3. The Phoenix and Stuttgart definitions were used for biochemical recurrence. Hazards ratio was calculated using HIFU cohort as a reference. The 5-year actuarial BRFS rates were significantly higher for the brachytherapy cohort compared to the HIFU cohort according to the Phoenix (68.5% versus 53%, HR = 0.41; CI 95%: 0.19–0.81, p < 0.05) and Stuttgart definitions (60.9% versus 53%, HR = 0.39; CI 95%: 0.19–0.74, p < 0.05), respectively. When stratifying patients according to the D'Amico risk and the technique used, BRFS rates were significantly higher for the low risk group treated by brachytherapy compared to the low risk group treated by HIFU according to Phoenix (77.5% versus 68%, HR = 0.31; CI 95%: 0.09–0.94, p = 0.05) and Stuttgart definitions (77.5% versus 56.3%, HR = 0.31; CI 95%: 0.10–0.84, p = 0.03), respectively (Figure 2).

Bottom Line: Results.Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p < 0.05).Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, 1000 Brussels, Belgium.

ABSTRACT
Purpose. To evaluate postoperative morbidity and long term oncologic and functional outcomes of high intensity focused ultrasound (HIFU) compared to brachytherapy for the treatment of localized prostate cancer. Material and Methods. Patients treated by brachytherapy were matched 1 : 1 with patients who underwent HIFU. Differences in postoperative complications across the two groups were assessed using Wilcoxon's rank-sum or χ (2) test. Kaplan-Meier curves, log-rank tests, and Cox regression models were constructed to assess differences in survival rates between the two groups. Results. Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p < 0.05). Median oncologic follow-up was 83 months (13-123 months) in the HIFU cohort and 44 months (13-89 months) in the brachytherapy cohort. Median time to achieve PSA nadir was statistically shorter in the HIFU. Biochemical recurrence-free survival rate was significantly higher in the brachytherapy cohort compared to HIFU cohort (68.5% versus 53%, p < 0.05). No statistically significant difference in metastasis-free, cancer specific, and overall survivals was observed between the two groups. Conclusion. HIFU and brachytherapy are safe with no significant difference in cancer specific survival on long term oncologic follow-up. Nonetheless, a randomized controlled trial is needed to confirm these results.

No MeSH data available.


Related in: MedlinePlus