title: Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly. A feasibility study with 10 years follow-up.
abstract: OBJECTIVE
  To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU).
  
  
  METHODS
  Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were: PSA ≤ 10 ng/mL, ≤ 3 positive biopsies with only 1 lobe involved, clinical stage ≤ T2a, Gleason score ≤ 7 (3+4), negative CT scan and bone scan. Hemi-ablation of the prostate was performed with the Ablatherm® device. Survival, complication rates and urinary continence were evaluated. Control biopsies were performed at 1 year. Treatment failure was defined as a positive biopsy or need for salvage therapy.
  
  
  RESULTS
  Twelve patients with a mean age 70 years were included. Median follow-up was 10 years. Control prostate biopsies were negative in 11/12 (91%) patients. Overall survival was 83% (10/12) and cancer specific survival was 100% at 10 years. Two patients died from other causes. Recurrence free survival was 90% (95% CI; 0.71-1) at 5 years, and 38% (95% CI; 0.04-0.73) at 10 years. Five patients had salvage therapy with repeat HIFU (n = 1) or hormonal therapy (n = 4) and all salvage patients were alive at 10 years. No patients developed lymph node or bone metastasis. No patients suffered from urinary incontinence. International Prostate Symptom Score was stable at 1 year. Complications included two urinary tract infections and one episode of acute urinary retention.
  
  
  CONCLUSIONS
  Hemi-prostate ablation with HIFU can be safely performed in selected elderly patients with adequate long-term cancer control and low complication rates. Results from larger prospective studies using improved imaging techniques and extensive biopsy protocols are awaited.
authors.affiliation: Department of Urology, Institute Montsouris, University Paris Descartes, Paris, France.
authors.forename: Amine B
authors.initials: AB
authors.lastname: El Fegoun
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.forename: Dominique
authors.initials: D
authors.lastname: Prapotnich
authors.forename: Shawn
authors.initials: S
authors.lastname: Soon
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.forename: François
authors.initials: F
authors.lastname: Rozet
authors.forename: Marc
authors.initials: M
authors.lastname: Galiano
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.forename: Guy
authors.initials: G
authors.lastname: Vallancien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D017430:Prostate-Specific Antigen