Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up
Int. braz. j. urol
;
37(2): 213-222, Mar.-Apr. 2011. graf, tab
Article
in English
| LILACS
| ID: lil-588994
ABSTRACT
PURPOSE:
To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU). MATERIALS ANDMETHODS:
Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were PSA < 10 ng/mL, < 3 positive biopsies with only 1 lobe involved, clinical stage < T2a, Gleason score < 7 (3+4), negative CT scan and bone scan. Hemi-ablation of the prostate was performed with the Ablatherm(R) device. Survival, complication rates and urinary continence were evaluated. Control biopsies were performed at 1 year. Treatment failure was defined as a positive biopsy or need for salvage therapy.RESULTS:
Twelve patients with a mean age 70 years were included. Median follow-up was 10 years. Control prostate biopsies were negative in 11/12 (91 percent) patients. Overall survival was 83 percent (10/12) and cancer specific survival was 100 percent at 10 years. Two patients died from other causes. Recurrence free survival was 90 percent (95 percent CI; 0.71-1) at 5 years, and 38 percent (95 percent CI; 0.04-0.73) at 10 years. Five patients had salvage therapy with repeat HIFU (n = 1) or hormonal therapy (n = 4) and all salvage patients were alive at 10 years. No patients developed lymph node or bone metastasis. No patients suffered from urinary incontinence. International Prostate Symptom Score was stable at 1 year. Complications included two urinary tract infections and one episode of acute urinary retention.CONCLUSIONS:
Hemi-prostate ablation with HIFU can be safely performed in selected elderly patients with adequate long-term cancer control and low complication rates. Results from larger prospective studies using improved imaging techniques and extensive biopsy protocols are awaited.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Prostatic Neoplasms
/
Ultrasound, High-Intensity Focused, Transrectal
Type of study:
Practice guideline
/
Observational study
/
Prognostic study
Limits:
Aged
/
Aged80
/
Humans
/
Male
Language:
English
Journal:
Int. braz. j. urol
Journal subject:
Urology
Year:
2011
Type:
Article
Affiliation country:
France
Institution/Affiliation country:
University Paris Descartes/FR
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