A whole of population, multi-user series of HIFU for management of localised prostate cancer: Outcomes and implications - Abstract

Objective: To determine the oncologic and complication outcomes of treatment of localised prostate cancer by High Intensity Focussed Ultrasound (HIFU) for primary treatment of prostate cancer in a whole of population, multi-user series.

Patients and Methods: We created a centralised database-accessible only by non-urologist researchers-within a cancer epidemiology centre, after ethics approval from that institution. A single researcher prospectively entered baseline, treatment and clinical/biochemical follow-up data from all patients managed with HIFU in the state of Victoria over the study period.

Results: We accrued 108 patients, of whom 103 had been staged as having clinically localised disease. Ninety-three patients (86.1%) had low or intermediate risk prostate cancer. Forty-four patients (40.5%) had persistent mild urinary incontinence at 3 months after treatment, and three of these ultimately underwent further surgical procedures to correct incontinence. Twenty-seven patients (25%) additionally experienced occasions of urinary retention in the first 3 months after treatment due to passage of tissue. Twenty-nine patients had achieved a PSA level of < 0.2 ng/mL at 3 months after HIFU. Fifty-six patients underwent post HIFU prostate biopsy and this was positive for residual cancer in 51 cases. Forty-five of the patients who had a positive post-HIFU biopsy underwent secondary treatment for prostate cancer.

Conclusion: Oncologic control and complication outcomes in this cohort were inferior to those previously reported for HIFU in single-user series. Given the population-based multi-user nature of our series we believe our observations are more likely to reflect the community outcomes that might be expected from widespread adoption of HIFU than generalising from single-operator series.

Written by:
Bolton D, Ong K, Giles G, Lawrentschuk N, Severi G, Papa NP, Troy A, Woo HH, Millar J, Royce P.   Are you the author?
University of Melbourne, Urology, 5/210 Burgundy street, Heidelberg, Melbourne, Victoria, Australia.  

Reference: J Endourol. 2015 Jan 26. Epub ahead of print.
doi: 10.1089/end.2014.0696

PubMed Abstract
PMID: 25621993

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