[Preliminary results of the treatment of 44 patients with localized cancer of the prostate using transrectal focused ultrasound].
OBJECTIVE
To evaluate the efficacy and morbidity of treatment of localized prostatic cancer using transrectal high-intensity focused ultrasound.


METHODS
44 patients (mean age: 72 years) with clinical stage T1 (20) or T2 (24) prostatic cancer, not eligible for radical prostatectomy, were treated by two different prototypes of the Ablatherm (Technomed Medical System). The second prototype includes several safety devices designed to reduce morbidity. 99 sessions were performed, i.e. an average of 2.25 sessions per patient: the prostate was treated in one session (5 patients), 2 sessions (26 patients), 3 sessions (10 patients), or 4 sessions (3 patients), usually under spinal anaesthesia. The mean PSA was 9.92 ng/ml and the mean prostatic weight was 37 g.


RESULTS
Complications occurred in 10 (50%) of the first 20 patients treated (1993-1995): 2 recto-urethral fistulas, 2 asymptomatic rectal burns, 2 cases of stable urinary retention, 1 case of severe incontinence, 3 cases of bladder neck sclerosis, and 1 febrile urinary tract infection. In the 24 patients treated subsequently (1995-1997), complications occurred in only 4 patients (16%): 1 case of stable urinary retention, 1 febrile urinary tract infection, 1 case of bladder neck sclerosis, 1 case of stress incontinence. A complete response (repeated negative follow-up biopsies) was obtained in 27 patients (61%). The mean post-treatment PSA level in patients of this group was 1.09 +/- 1.06 and remained stable (mean follow-up: 346 days; range: 60-1250). A residual cancer was detected in 17 patients (39%). 8 patients were considered to be failures (mean post-treatment PSA: 4.8 ng/ml) and received adjuvant treatment (hormonal: 3; external radiotherapy: 5). Complementary treatment by focused ultrasound will be performed in another 9 patients, if their PSA rises above 3 ng/ml (patients of this group are symptomatic with a mean post-treatment PSA of 1.6 ng/ml).


CONCLUSIONS
The morbidity of treatment by transrectal focused ultrasound has now been reduced. These results suggest that this new treatment can constitute a useful option for certain patients with localized cancer, not suitable for radical prostatectomy.
Gelet
A
A
Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard Herriot, Lyon, France.
Chapelon
J Y
JY
Bouvier
R
R
Pangaud
C
C
Souchon
R
R
Blanc
E
E
Cathignol
D
D
Dubernard
J M
JM
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000775:Anesthesia, Spinal; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D002056:Burns / Q000209:etiology; D017024:Chemotherapy, Adjuvant; D000075202:Contraindications; D004869:Equipment Safety; D005069:Evaluation Studies as Topic; D005334:Fever / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009929:Organ Size; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D012003:Rectal Fistula / Q000209:etiology; D012007:Rectum / Q000293:injuries; D012074:Remission Induction; D012598:Sclerosis; D017211:Treatment Failure; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D014522:Urethral Diseases / Q000209:etiology; D001743:Urinary Bladder / Q000473:pathology; D014548:Urinary Fistula / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology; D014550:Urinary Incontinence, Stress / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology
D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen
Résultats préliminaires du traitement de 44 patients porteurs de cancers localisés de la prostate par ultrasons focalisés transrectaux.