BERKELEY, CA (UroToday.com) -High-intensity focused ultrasound (HIFU) is gaining popularity as a potential new treatment for localized prostate cancer (CaP). Long-term outcomes have been lacking. In the online version of European Urology, Dr. Blana and associates present outcomes on HIFU patients with a mean followup of 6.4 years.

HIFU works by coagulation necrosis of the prostate tissue. Patients in this report were treated with either a prototype or the first-generation Ablatherm Maxis HIFU devise. Inclusion criterion for treatment were a PSA ‹ 15ng/ml, clinical stage T1-2NxM0, and Gleason score ‹ 7. The endpoints reported were overall survival (OS), prostate cancer-specific survival (PCSS), the Phoenix definition of biochemical failure (PSA nadir + 2), and disease free survival (DFS). A total of 140 patients were included; 72 low-risk and 68 intermediate risk. The mean number of HIFU sessions was 1.3 years with 1, 2, and 3 sessions for 99, 39, and 2 patients, respectively. Hormonal therapy was given to 23 men for a mean duration of 51 days but no differences were observed compared to those not receiving hormonal therapy. The mean time to PSA nadir was 4.9 months and the mean PSA nadir value was 0.16ng/ml. The mean final PSA level measured was 1.9ng/ml for low risk patients and 0.9ng/ml for intermediate risk patients. A total of 132 of the 140 participants had a followup biopsy and these were negative in 114 (86%). Of these 114 men 14 did subsequently develop biochemical failure.

The actuarial 5 and 8 year survival rates were 90% and 83%, respectively and PCSS at 5 and 8 years were 100% and 98%, respectively. In multivariable analysis, only age was statistically significant for OS. Fifteen percent of patients received salvage therapy, more commonly in intermediate risk patients. The actuarial biochemical failure free survival rates at 5 and 7 years were 77% and 69%. A total of 30 patients (21.4%) were considered biochemical failures after HIFU. The actuarial 7 year DFS rate was 59%. A total of 47 men (34%) were considered as HIFU treatment failures.

In the 30 month postoperative period, 48 patients (34%) presented with at least 1 episode of incontinence but at final evaluation 94% were continent. In an accompanying editorial by Dr. James Eastham of MSKCC he points out that the Phoenix definition is only for external beam radiotherapy and the side effects reported “temper the enthusiasm for HIFU”.

Blana A, Murat FJ, Walter B, Thuroff S, Wieland WF, Chaussy C, Gelet A

Eur Urol. ePub Ahead of Print
doi: 10.1016/j.eururo.2007.10.062

PubMed Abstract
PMID:17997026

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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