Control of prostate cancer by transrectal HIFU in 227 patients

Purpose: To evaluate the results of high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer with reference to disease-related prognostic factors. Materials and methods: Patients with T1-2 localized prostate cancers, prostate specific antigen (PSA) <= 15 ng/ml, Gleason score < 7, prostate volume <= 40 cc and no previous radical treatment for prostate cancer were treated with the Ablatherm HIFU device. Follow-up included PSA measurements, and prostate biopsies 3 months after HIFU and in cases of rising PSA. Failure was defined as any positive biopsy or a PSA > 1 ng/ml with three consecutive rises. Results: The study included 227 patients. Mean follow-up was 27 20 months (12-121 months). Eighty-six percent had negative control biopsies. Median nadir PSA was 0.10 ng/ml. The actuarial 5-year disease-free survival rate (DFSR), combining pathologic and biochemical outcomes, was 66%. DFSR showed a significant decrease when stratified according to initial PSA level: 90% with PSA < 4 ng/ml versus 57% and 61% with PSA between 4.1 and 10, and between 10.1 and 15 ng/ ml, respectively. Incontinence and bladder neck stricture decreased with the treatment procedure standardization from 28% and 31% to 9% and 6%, respectively. Conclusions: HIFU for localized prostate cancer offered high control of local disease with low morbidity. The ability to repeat the HIFU treatment is of major interest. (c) 2006 Published by Elsevier B.V. on behalf of European Association of Urology.