Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer.
OBJECTIVE
Criteria for determining the durability of the response to transrectal high-intensity focused ultrasound (HIFU) ablation of prostate cancer have been established by calculating progression-free probability.


METHODS
A series of 82 patients (mean age 71 +/- 5.7 years) with biopsy-proven localized (stage T1-T2) cancer who were not suitable candidates for radical surgery underwent transfectal HIFU ablation with the Ablatherm machine. The mean follow-up was 17.6 months (range 3-68 months). The mean serum prostate specific antigen (PSA) value and mean prostate volume were 8.11 +/- 4.64 ng/mL and 34.9 +/- 17.4 cm3, respectively. Progression was rigidly defined as any positive biopsy result, regardless of PSA concentration, or three successive PSA increases for patients with a negative biopsy (PSA velocity > or = 0.75). Times to specific events (positive biopsy and PSA elevation) were analyzed with the Kaplan-Meier survival method.


RESULTS
Overall, 62% of the patients exhibited no evidence of disease progression 60 months after transrectal HIFU ablation. In particular, the disease-free rate was 68% for the moderate-risk group of 50 patients (PSA < 15.0 ng/mL, Gleason sum < 8, prostate volume < 40 cm3, and number of positive biopsies < 5). For the low-risk group of 32 patients (PSA < 10 ng/mL and Gleason sum < 7), the disease-free survival rate was 83%.


CONCLUSIONS
Transrectal HIFU prostate ablation is an effective therapeutic alternative for patients with localized prostatic adenocarcinoma.
Gelet
A
A
Urology Department, Edouard Herriot Hospital, Lyon, France. gelet@lyon151.inserm.fr
Chapelon
J Y
JY
Bouvier
R
R
Rouvière
O
O
Lasne
Y
Y
Lyonnet
D
D
Dubernard
J M
JM
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D018450:Disease Progression; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy; D018084:Ultrasonography, Interventional / Q000379:methods*
D017430:Prostate-Specific Antigen