title: Six years' experience with high-intensity focused ultrasonography for prostate cancer: oncological outcomes using the new 'Stuttgart' definition for biochemical failure.
abstract: OBJECTIVE
  • To determine oncological outcomes after high-intensity focused ultrasonography (HIFU) treatment in patients with localized prostate cancer using a new, more accurate, definition ('Stuttgart' definition) of biochemical failure.
  
  
  METHODS
  • We performed a retrospective review of all patients in our centre who received first-line treatment with a second-generation Ablatherm™ device (EDAP-TMS, Lyon, France). • Oncological failure was given either by biochemical failure (prostate-specific antigen, PSA, nadir plus 1.2 g/mL) (Stuttgart definition) or the start of salvage therapy because of a persistently positive biopsy after the HIFU procedure. • The 5-year biochemical-free survival rate and 5-year disease-free survival rate were calculated.
  
  
  RESULTS
  • In total, 53 patients were included (mean age, 72.5 ± 4.5 years, range 60-79 years; 28 low risk and 25 intermediate risk). None had undergone previous hormonal therapy. Mean ±sd follow-up was 45.4 ± 15.5 months (range 16-71 years). Mean (range) pre-treatment PSA was 8.5 ± 4 (0.29-18) ng/mL. The median (range) PSA nadir value was 1 (0.01-14) ng/mL and occurred after a mean (range) of 5.09 (3-24) months. • Overall, 36 patients (67.9%) experienced oncological failure. • These included 33 cases (62.2%) of biochemical failure. A PSA nadir of ≤0.2, 0.21-1.0 and >1 ng/mL was reached in 20.8%, 30.2% and 49% of patients, respectively, and was associated with biochemical failure in 9.1%, 30.3% and 60.6%, respectively. • The 5-year biochemical-free survival rate and disease-free survival rate were 21.7% and 13.5%, respectively. In multivariate analysis, a PSA nadir of >1 ng/mL was significantly associated with a risk of biochemical and oncological failure (P= 0.002 and P < 0.001). • Oncological failure was not associated with any risk group. • No patient died from prostate cancer.
  
  
  CONCLUSIONS
  • In our experience, Ablatherm™ treatment for clinically localized prostate cancer was associated with a high rate of biochemical failure as determined by the 'Stuttgart' definition, and did not achieve effective cancer control. • The PSA nadir value after HIFU treatment was a significant predictor of treatment failure.
authors.affiliation: Department of Urology and Andrology, CHU Reims, France. thomas_ripert@yahoo.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Ripert
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Azémar
authors.forename: Johann
authors.initials: J
authors.lastname: Ménard
authors.forename: Coralie
authors.initials: C
authors.lastname: Barbe
authors.forename: Rabah
authors.initials: R
authors.lastname: Messaoudi
authors.forename: Younes
authors.initials: Y
authors.lastname: Bayoud
authors.forename: Jean
authors.initials: J
authors.lastname: Pierrevelcin
authors.forename: François
authors.initials: F
authors.lastname: Duval
authors.forename: Frédéric
authors.initials: F
authors.lastname: Staerman
mesh_terms: D000368:Aged; D001706:Biopsy; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000628:therapy*; D016879:Salvage Therapy / Q000379:methods*; D017211:Treatment Failure; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D017430:Prostate-Specific Antigen