World Journal of Urology

, Volume 26, Issue 5, pp 481–485 | Cite as

Oncologic control provided by HIFU therapy as single treatment in men with clinically localized prostate cancer

  • Vincent Misraï
  • Morgan Rouprêt
  • Emmanuel Chartier-Kastler
  • Eva Comperat
  • Raphaële Renard-Penna
  • Alain Haertig
  • Marc-Olivier Bitker
  • François Richard
  • Pierre Conort
Original Article

Abstract

Objective

To assess the long term oncologic results of high-intensity focused ultrasound therapy (HIFU) as a primary and single treatment for clinically localized prostate cancer.

Methods

A total of 119 patients with clinically localized prostate cancer underwent HIFU (Ablatherm®, EDAP, France) as first-line treatment and were retrospectively reviewed. They were stratified according to risk groups proposed by D’Amico. No patient had undergone previous hormonal therapy. PSA level was monitored at 3, 6, 12, 18, 24 months and then yearly. According to the latest ASTRO criteria, failure was defined by a PSA rise of 2 ng/ml or more above the PSA nadir. The biochemical-free survival rate (BFSR) was calculated.

Results

Mean patient age was 68 ± 7.8 years (46–83). Mean follow-up was 3.9 years (1–6.8). Overall 52 patients (43.7%) experienced a biochemical recurrence which included 26, 23 and 3 patients in the low, intermediate and high-risk groups, respectively. In univariate and multivariate analyses, there was a statistical association between preoperative PSA value > 10, a nadir PSA value > 1 and the risk of biochemical recurrence (P < 0.05). The 5-year BFSR rate was 30% with no statistical difference between low- and intermediate-risk patients. None of the 119 patients died of prostate cancer.

Conclusion

High-intensity focused ultrasound therapy provides efficient oncologic control only in patients with low-risk prostate cancer. However, our data could be used to improve the selection of patients who are potential candidates for HIFU therapy.

Keywords

Localized prostate cancer HIFU Outcome Minimally invasive therapy Prostate-specific antigen 

Notes

Acknowledgments

The authors want to thank kindly Mathieu Coudert who performed the statistical part of this work at the Department of Statistics, Faculté de Médecine Pierre et Marie Curie, Pitié-Salpétrière Hospital, University Paris 6, Paris, France.

Conflict of interest statement

There is no conflict of interest.

References

  1. 1.
    Boyle P, Severi G, Giles GG (2003) The epidemiology of prostate cancer. Urol Clin North Am 30:209–217PubMedCrossRefGoogle Scholar
  2. 2.
    Oliver SE, May MT, Gunnell D (2001) International trends in prostate-cancer mortality in the “PSA ERA”. Int J Cancer 92:893–898PubMedCrossRefGoogle Scholar
  3. 3.
    Walsh PC, DeWeese TL, Eisenberger MA (2007) Clinical practice. Localized prostate cancer. N Engl J Med 357:2696–2705Google Scholar
  4. 4.
    Chaussy C, Thuroff S (2001) Results and side effects of high-intensity focused ultrasound in localized prostate cancer. J Endourol 15:437–440 discussion 447–448PubMedCrossRefGoogle Scholar
  5. 5.
    Vallancien G, Prapotnich D, Cathelineau X, Baumert H, Rozet F (2004) Transrectal focused ultrasound combined with transurethral resection of the prostate for the treatment of localized prostate cancer: feasibility study. J Urol 171:2265–2267PubMedCrossRefGoogle Scholar
  6. 6.
    Blana A, Murat FJ, Walter B, Thuroff S, Wieland WF, Chaussy C et al (2007) First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. Eur Urol 53(6):1194–1203PubMedCrossRefGoogle Scholar
  7. 7.
    Blana A, Walter B, Rogenhofer S, Wieland WF (2004) High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. Urology 63:297–300PubMedCrossRefGoogle Scholar
  8. 8.
    Gelet A, Chapelon JY, Bouvier R, Rouviere O, Lyonnet D, Dubernard JM (2001) Transrectal high intensity focused ultrasound for the treatment of localized prostate cancer: factors influencing the outcome. Eur Urol 40:124–129PubMedCrossRefGoogle Scholar
  9. 9.
    Ganzer R, Rogenhofer S, Walter B, Lunz JC, Schostak M, Wieland WF et al (2007) PSA nadir is a significant predictor of treatment failure after high-intensity focussed ultrasound (HIFU) treatment of localised prostate cancer. Eur Urol 53(3):547–553PubMedCrossRefGoogle Scholar
  10. 10.
    Poissonnier L, Chapelon JY, Rouviere O, Curiel L, Bouvier R, Martin X et al (2007) Control of prostate cancer by transrectal HIFU in 227 patients. Eur Urol 51:381–387PubMedCrossRefGoogle Scholar
  11. 11.
    D’Amico AV, Cote K, Loffredo M, Renshaw AA, Schultz D (2002) Determinants of prostate cancer-specific survival after radiation therapy for patients with clinically localized prostate cancer. J Clin Oncol 20:4567–4573PubMedCrossRefGoogle Scholar
  12. 12.
    Roach M 3rd, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65:965–974PubMedGoogle Scholar
  13. 13.
    Uchida T, Ohkusa H, Nagata Y, Hyodo T, Satoh T, Irie A (2006) Treatment of localized prostate cancer using high-intensity focused ultrasound. BJU Int 97:56–61PubMedCrossRefGoogle Scholar
  14. 14.
    Rebillard X, Davin JL, Soulie M (2003) Treatment by HIFU of prostate cancer: survey of literature and treatment indications. Prog Urol 13:1428–1456PubMedGoogle Scholar
  15. 15.
    Rebillard X, Soulie M, Chartier-Kastler E, Coulange C, Davin J, Moreau J et al (2008) High-intensity focused ultrasound in prostate cancer; a systematic literature review of the French Association of Urology. BJU Int 101:1205–1213PubMedCrossRefGoogle Scholar
  16. 16.
    Lee HM, Hong JH, Choi HY (2006) High-intensity focused ultrasound therapy for clinically localized prostate cancer. Prostate Cancer Prostatic Dis 9:439–443PubMedCrossRefGoogle Scholar
  17. 17.
    Gulley JL, Figg WD, Steinberg SM, Carter J, Sartor O, Higano CS et al (2005) A prospective analysis of the time to normalization of serum androgens following 6 months of androgen deprivation therapy in patients on a randomized phase III clinical trial using limited hormonal therapy. J Urol 173:1567–1571PubMedCrossRefGoogle Scholar
  18. 18.
    Thuroff S, Chaussy C, Vallancien G, Wieland W, Kiel HJ, Le Duc A et al (2003) High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. J Endourol 17:673–677PubMedCrossRefGoogle Scholar
  19. 19.
    Chaussy C, Thuroff S (2000) High-intensity focused ultrasound in prostate cancer: results after 3 years. Mol Urol 4:179–182PubMedGoogle Scholar
  20. 20.
    Chaussy C, Thuroff S (2003) The status of high-intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection. Curr Urol Rep 4:248–252PubMedCrossRefGoogle Scholar
  21. 21.
    Murat FJ, Poissonnier L, Pasticier G, Gelet A (2007) High-intensity focused ultrasound (HIFU) for prostate cancer. Cancer Control 14:244–249PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Vincent Misraï
    • 1
  • Morgan Rouprêt
    • 1
  • Emmanuel Chartier-Kastler
    • 1
    • 4
  • Eva Comperat
    • 2
  • Raphaële Renard-Penna
    • 3
  • Alain Haertig
    • 1
  • Marc-Olivier Bitker
    • 1
  • François Richard
    • 1
  • Pierre Conort
    • 1
  1. 1.Department of Urology of Pitié-Salpétrière Hospital, Groupe Hospitalo-Univeristaire EST, Assistance Publique-Hôpitaux de Paris; Faculté de Médecine Pierre et Marie CurieUniversity Paris VIParisFrance
  2. 2.Department of Pathology of Pitié-Salpétrière Hospital, Groupe Hospitalo-Univeristaire EST, Assistance Publique-Hôpitaux de Paris; Faculté de Médecine Pierre et Marie CurieUniversity Paris VIParisFrance
  3. 3.Department of Radiology of Pitié-Salpétrière Hospital, Groupe Hospitalo-Univeristaire EST, Assistance Publique-Hôpitaux de Paris; Faculté de Médecine Pierre et Marie CurieUniversity Paris VIParisFrance
  4. 4.Academic Urology DepartmentHopital PitiéParisFrance

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