title: High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series.
abstract: BACKGROUND
  The use of minimally invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy.
  
  
  METHODS
  An analysis of men with organ-confined prostate cancer treated with transrectal whole-gland HIFU (Sonablate 500) between 1 February 2005 and 15 May 2007 was carried out in two centres. Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated.
  
  
  RESULTS
  A total of 172 men were treated under general anaesthetic as day-case procedures with 78% discharged a mean 5 h after treatment. Mean follow-up was 346 days (range 135-759 days). Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P=0.005). Antibiotics were given to 23.8% of patients for presumed urinary tract infection and the rate of epididymitis was 7.6%. Potency was maintained in 70% by 12 months, whereas mild stress urinary incontinence (no pads) was reported in 7.0% (12 out of 172) with a further 0.6% (1 out of 172) requiring pads. There was no rectal toxicity and no recto-urethral fistulae. In all, 78.3% achieved a PSA nadir < or =0.5 microg ml(-1) at 12 months, with 57.8% achieving < or =0.2 microg ml(-1). Then, 8 out of 13 were retreated with HIFU, one had salvage external beam radiotherapy and four chose active surveillance for small-volume low-risk disease. Overall, there was no evidence of disease (PSA <0.5 microg ml(-1) or negative biopsy if nadir not achieved) after one HIFU session in 92.4% (159 out of 172) of patients.
  
  
  CONCLUSIONS
  HIFU is a minimally invasive, day-case ablative technique that can achieve good biochemical outcomes in the short term with minimal urinary incontinence and acceptable levels of erectile dysfunction. Long-term outcome needs further evaluation and the inception of an international registry for cases treated using HIFU will significantly aid this health technology assessment.
authors.affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK. hashim.ahmed@ucl.ac.uk
authors.forename: H U
authors.initials: HU
authors.lastname: Ahmed
authors.forename: E
authors.initials: E
authors.lastname: Zacharakis
authors.forename: T
authors.initials: T
authors.lastname: Dudderidge
authors.forename: J N
authors.initials: JN
authors.lastname: Armitage
authors.forename: R
authors.initials: R
authors.lastname: Scott
authors.forename: J
authors.initials: J
authors.lastname: Calleary
authors.forename: R
authors.initials: R
authors.lastname: Illing
authors.forename: A
authors.initials: A
authors.lastname: Kirkham
authors.forename: A
authors.initials: A
authors.lastname: Freeman
authors.forename: C
authors.initials: C
authors.lastname: Ogden
authors.forename: C
authors.initials: C
authors.lastname: Allen
authors.forename: M
authors.initials: M
authors.lastname: Emberton
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects / Q000379:methods*; D006113:United Kingdom; D014546:Urinary Catheterization / Q000009:adverse effects
chemical_list: D017430:Prostate-Specific Antigen