Improved outcomes owing to high-intensity focused ultrasound devices version-up for the treatment of patients with localized prostate cancer - Abstract

PURPOSE: To evaluate the association between long-term clinical outcomes and morbidity of high-intensity focused ultrasound (HIFU).

MATERIALS AND METHODS: We included patients with stage T1c-T3N0M0 prostate cancer who were treated with Sonablate™ (SB) devices during 1999-2012 and followed-up for >2 years. Risk stratification and complication rates were compared between the treatment groups (i.e., SB200/500 group, SB500 version 4 group, and the SB500 tissue change monitor (TCM) group). Primary study outcomes included the overall and cancer-specific survival and biochemical disease-free survival (BDFS) rates, determined using the Kaplan-Meier analysis (Phoenix definition). Secondary outcomes included predictors of BDFS rates using Cox models.

RESULTS: A total of 918 patients were included. The median follow-up periods in the B200/500, SB500 version 4, and the SB500 TCM groups were 108, 83, and 47 months, respectively. The 10-year overall and cancer-specific survival rates were 89.6% and 97.4%, respectively. The 5-year BDFS rates in the SB200/500, SB500 version 4, and SB500 TCM groups were 48.3%, 62.3%, and 82.0%, respectively (p < 0.0001). The overall negative biopsy rate was 87.3%. According to the multivariate analysis, pre-treatment PSA, Gleason score, stage, neoadjuvant androgen deprivation therapy, and HIFU devices were significant predictors of BDFS. Urethral stricture, epididymitis, urinary incontinence, and rectourethral fistula were observed in 19.7%, 6.2%, 2.3% and 0.1% of the cases, respectively.

CONCLUSIONS: Long-term follow-up of patients with HIFU demonstrated improved clinical outcomes owing to technical, imaging, and technological advancements.

Written by:
Uchida T, Tomonaga T, Kim H, Nakano M, Shoji S, Nagata Y, Terachi T.   Are you the author?
Department of Urology, Tokai University Hachioji Hospital, Hachioji, Japan;  Department of Urology, Tokai University, Isehara, Japan.  

Reference: J Urol. 2014 Jul 28. pii: S0022-5347(14)04047-6.
doi: 10.1016/j.juro.2014.07.096

PubMed Abstract
PMID: 25079940 Prostate Cancer Section