Results of low threshold to biopsy following high-intensity focused ultrasound for localized prostate cancer

There are different treatment options for localized prostate cancer. The success of high-intensity focused ultrasound [HIFU] is based largely on biochemical prostate specific antigen [PSA] results. To evaluate the impact of using a low PSA threshold to perform prostate biopsies after HIFU in order to more accurately gauge treatment success. Eleven patients underwent HIFU at Sydney Adventist Hospital in Sydney, 10 as primary and 1 as salvage therapy [post external beam radiation therapy [EBRT]]. The median age was 67 years [49-77 years]. This was a prospective case series. Between 2006 and 2008, the Sonoblate device was used. Prostate biopsies were 12-core biopsies performed under local anesthesia, if PSA was >/= 0.5 ng/mL or after two consecutive rises in PSA. The statistical analysis involved prospective data collection of results to calculate median and ranges. The median PSA at diagnosis was 6.7 ng/mL [5.7-10.8 ng/mL]. The median follow-up was 16 months [7-26 months]. Nine men [82%] had post-HIFU biopsy. The median time to post-HIFU biopsy was 11.6 months [5-20 months], and all nine men had biopsy-proven residual disease. A low threshold to re-biopsy post-HIFU reveals a high local failure rate of 82%. Oncological efficacy is questioned, and using high threshold to biopsy may therefore be overestimating the effectiveness of HIFU as a primary treatment for localized prostate cancer

Photoselective vaporization of the prostate in men taking clopidogrel

To evaluate the peri-operative morbidity of men taking clopidogrel who underwent photoselective vaporisation of the prostate [PVP]. A prospective database was collected. Between March 2005 and July 2010, 480 men underwent PVP. Of these, 18 men underwent PVP treatment while on clopidogrel. The surgery was carried out with either an 80W KTP laser or a 120W lithium triborate laser. In the peri-operative period there were no complications related to PVP. There were no urinary tract infections, nor did any patient require bladder re-catheterisation. No cardiovascular events were reported within 3 months of the procedure. At 3 months post operatively, the International Prostate Symptom Score +/- standard deviation had improved from was 17.5 +/- 10.6 to 9.2 +/- 6.1 P<0.05. While the Quality of Life +/- standard deviation improved from 4.7 +/- 1.2 to 2.2 +/- 1.5 P<0.01. The maximum flow rate [Qmax], and post void residual volume [PVR] improved from 6.2 +/- 3.0 mL/s to 19.7 +/- 9.1 mL/s [P<0.01], and 140 +/- 102 mL to 59 +/- 77 mL [P<0.05], respectively. PVP is a safe and efficacious in the treatment of high risk patients with bladder outlet obstruction. Further, the ability to continue therapeutic anticoagulation and anti-platelet agents, is a significant advantage over Holmium enucleation of the prostate and conventional transurethral resection of the prostate. Larger studies with greater numbers of patients are required prior to PVP becoming the gold standard for high-risk patients with bladder outlet obstruction