Transurethral resection of the prostate immediately after high-intensity focused ultrasound treatment for prostate cancer.
OBJECTIVE
To evaluate the long-term outcomes of transurethral resection of the prostate (TURP) immediately after high-intensity focused ultrasound (HIFU) treatment for prostate cancer (CaP).


METHODS
The present retrospective study included 65 CaP patients who underwent HIFU alone and 64 patients who underwent TURP immediately after HIFU. HIFU treatment was carried out using a Sonablate-500 HIFU device (Focus Surgery, Indianapolis, IN, USA). International Prostate Symptom Score (IPSS) and the occurrence of urinary complications, such as urethral stricture during follow-up, were statistically compared between groups.


RESULTS
Clinical stage tended to be lower for the HIFU+TURP group (P=0.0311), but none of the preoperative parameters differed significantly between groups. Both catheterization time (P<0.0001) and post-treatment IPSS (P<0.0001) at 6, 12, and 24months after treatment differed significantly between groups. Urethral strictures were noted in 16 (24.6%) of the HIFU-only patients and seven (10.9%) of the HIFU+TURP patients. Bladder neck contracture was noted in 11 (68.8%) of the patients with urethral stricture in the HIFU-only group, but in just two (28.6%) of the patients with urethral stricture in the HIFU+TURP group. Multiple logistic regression analyses showed that TURP resection volume (P=0.0118) was a strong factor for the prevention of urethral stricture.


CONCLUSIONS
Our results suggest that combining HIFU with an immediately following TURP improves post-treatment urinary status without causing additional morbidity.
Sumitomo
Makoto
M
Department of Urology, National Defense Medical College, Tokorozawa, Saitama Department of Urology, Musashino Yohwakai Hospital, Musashino, Tokyo, Japan. mh712sumitomo@ybb.ne.jp
Asakuma
Junichi
J
Sato
Akinori
A
Ito
Keiichi
K
Nagakura
Kazuhiko
K
Asano
Tomohiko
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects / Q000379:methods*; D014525:Urethral Stricture / Q000209:etiology / Q000503:physiopathology; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology
D017430:Prostate-Specific Antigen