Fourteen‐year oncological and functional outcomes of high‐intensity focused ultrasound in localized prostate cancer

Medientyp: E-Artikel
Titel: Fourteen‐year oncological and functional outcomes of high‐intensity focused ultrasound in localized prostate cancer
Beteiligte: Ganzer, Roman; Fritsche, Hans‐Martin; Brandtner, Andreas; Bründl, Johannes; Koch, Daniel; Wieland, Wolf F.; Blana, Andreas
Erschienen: Wiley, 2013
Erschienen in: BJU International
Sprache: Englisch
DOI: 10.1111/j.1464-410x.2012.11715.x
ISSN: 1464-4096; 1464-410X
Schlagwörter: Urology
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Beschreibung: <jats:sec><jats:title>What's known on the subject? and What does the study add?</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>High‐intensity focused ultrasound (<jats:styled-content style="fixed-case">HIFU</jats:styled-content>) is an alternative treatment option for localized prostate cancer (<jats:styled-content style="fixed-case">PCa</jats:styled-content>), which is applied for over 15 years. There are conflicting recommendations for <jats:styled-content style="fixed-case">HIFU</jats:styled-content> among urological societies, which can be explained by the lack of prospective controlled studies, reports on preselected patient populations and limited follow‐up providing little information on overall and cancer‐specific survival.</jats:p></jats:list-item> <jats:list-item><jats:p>We report on a large, unselected consecutive patient series of patients who have undergone primary <jats:styled-content style="fixed-case">HIFU</jats:styled-content> for clinically localized <jats:styled-content style="fixed-case">PCa</jats:styled-content> with the longest follow‐up in current literature. Our results improve the understanding of the oncological efficacy, morbidity and side effects of primary <jats:styled-content style="fixed-case">HIFU</jats:styled-content>.</jats:p></jats:list-item> </jats:list></jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>To assess the safety, functional and oncological long‐term outcomes of high‐intensity focused ultrasound (<jats:styled-content style="fixed-case">HIFU</jats:styled-content>) as a primary treatment option for localized prostate cancer (<jats:styled-content style="fixed-case">PCa</jats:styled-content>).</jats:p></jats:list-item> </jats:list></jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>We conducted a retrospective single‐centre study on 538 consecutive patients who underwent primary <jats:styled-content style="fixed-case">HIFU</jats:styled-content> for clinically localized <jats:styled-content style="fixed-case">PCa</jats:styled-content> between <jats:styled-content style="fixed-case">N</jats:styled-content>ovember 1997 and <jats:styled-content style="fixed-case">S</jats:styled-content>eptember 2009.</jats:p></jats:list-item> <jats:list-item><jats:p>Factors assessed were: biochemical disease‐free survival (<jats:styled-content style="fixed-case">BDFS</jats:styled-content>) according to <jats:styled-content style="fixed-case">P</jats:styled-content>hoenix criteria (prostate‐specific antigen nadir + 2 ng/<jats:styled-content style="fixed-case">mL</jats:styled-content>); metastatic‐free, overall and <jats:styled-content style="fixed-case">PCa</jats:styled-content>‐specific survival; salvage treatment; side effects; potency; and continence status.</jats:p></jats:list-item> </jats:list></jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>The mean (<jats:sc>sd</jats:sc>; range) follow‐up was 8.1 (2.9; 2.1–14.0) years.</jats:p></jats:list-item> <jats:list-item><jats:p>The actuarial <jats:styled-content style="fixed-case">BDFS</jats:styled-content> rates at 5 and 10 years were 81 and 61%, respectively. The 5‐year <jats:styled-content style="fixed-case">BDFS</jats:styled-content> rates for low‐, intermediate‐ and high‐risk patients were 88, 83 and 48%, while the 10‐year <jats:styled-content style="fixed-case">BDFS</jats:styled-content> rates were 71, 63 and 32%, respectively.</jats:p></jats:list-item> <jats:list-item><jats:p>Metastatic disease was reported in 0.4, 5.7 and 15.4% of low‐, intermediate‐ and high‐risk patients, respectively.</jats:p></jats:list-item> <jats:list-item><jats:p>The salvage treatment rate was 18%.</jats:p></jats:list-item> <jats:list-item><jats:p>Seventy‐five (13.9%) patients died. <jats:styled-content style="fixed-case">PCa</jats:styled-content>‐specific death was registered in 18 (3.3%) patients (0, 3.8 and 11% in the low‐, intermediate‐ and high‐risk groups, respectively).</jats:p></jats:list-item> <jats:list-item><jats:p>Side effects included bladder outlet obstruction (28.3%), Grade <jats:styled-content style="fixed-case">I</jats:styled-content>, <jats:styled-content style="fixed-case">II</jats:styled-content> and <jats:styled-content style="fixed-case">III</jats:styled-content> stress urinary incontinence (13.8, 2.4 and 0.7%, respectively) and recto‐urethral fistula (0.7%). Preserved potency was 25.4% (in previously potent patients).</jats:p></jats:list-item> </jats:list></jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>The study demonstrates the efficacy and safety of <jats:styled-content style="fixed-case">HIFU</jats:styled-content> for localized <jats:styled-content style="fixed-case">PCa</jats:styled-content>.</jats:p></jats:list-item> <jats:list-item><jats:p><jats:styled-content style="fixed-case">HIFU</jats:styled-content> is a therapeutic option for patients of advanced age, in the low‐ or intermediate‐risk groups, and with a life expectancy of ∼10 years.</jats:p></jats:list-item> </jats:list></jats:p></jats:sec>

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