title: Clinically significant urethral stricture and/or subclinical urethral stricture after high-intensity focused ultrasound correlates with disease-free survival in patients with localized prostate cancer.
abstract: OBJECTIVE
  To assess the association between the development of a urethral stricture (US) and disease-free survival for patients with localized prostate cancer treated with high-intensity focused ultrasound (HIFU).
  
  
  METHODS
  Patients with clinical stage T1-T2N0M0 prostate cancer were eligible for treatment with HIFU. Treatment failure was defined according to the Phoenix criteria, and the disease-free survival rate (DFSR) was evaluated using this definition. Patients were divided into two subgroups according to whether or not they developed a US or a subclinical urethral stricture (SCUS) during follow-up. SCUS was defined as clinically insignificant bladder outlet obstruction requiring transient catheterization.
  
  
  RESULTS
  A total of 144 patients were included in the present study. The median follow-up time was 47 months (range 2-70). Grade 1-4 US occurred during follow-up in 28 (19.5%) patients and SCUS was found in 30 (20.8%). The 5-year DFSR by Kaplan-Meier estimation was 61.2% for the entire cohort, 78.2% for patients who developed a US/SCUS and 47.8% for those without US or SCUS (p < 0.001). On Cox regression analysis, development of US/SCUS proved to be an independent predictor of DFSR.
  
  
  CONCLUSIONS
  Development of US/SCUS was identified as a predictor of favorable HIFU treatment outcome.
authors.affiliation: Department of Urology, Osaka Medical College, Osaka, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Komura
authors.forename: Teruo
authors.initials: T
authors.lastname: Inamoto
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Fujisue
authors.forename: Yoji
authors.initials: Y
authors.lastname: Katsuoka
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Watsuji
authors.forename: Haruhito
authors.initials: H
authors.lastname: Azuma
mesh_terms: D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000096:biosynthesis; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects*; D014463:Ultrasonography; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects*; D014525:Urethral Stricture / Q000175:diagnosis*
chemical_list: D017430:Prostate-Specific Antigen