title: Results of high intensity focused ultrasound treatment of prostate cancer:  early Canadian experience at a single center.
abstract: BACKGROUND
  High intensity focused ultrasound (HIFU) is a non-invasive technique that uses focused ultrasound waves to ablate tissue.  This retrospective study evaluates the early HIFU experience at a single Canadian center.
  
  
  METHODS
  Ninety-five patients were treated between March 2006 and December 2007 using the Sonablate-500 device (Focus Surgery, Indianapolis, IN, USA).  Follow up occurred at 3 month intervals and included serial prostate-specific antigen (PSA) measurements, assessments of erectile function and continence rates with the international index of erectile function (IIEF) and expanded prostate cancer index composite (EPIC) questionnaires respectively.  Early and late complications were also studied.
  
  
  RESULTS
  There were 95 patients treated by five urologists.  The mean age of patients was 64 years (range 46-91).  The majority of men treated had Gleason 6 (n = 53) or Gleason 7 (n = 35) disease.  The remainder had Gleason 8 (n = 5) and Gleason 9 (n = 2) prostate cancer.  Prostate volume in the pre-treatment group was 30.5 cc (range 14.4 cc-73 cc).  Cytoreductive androgen deprivation therapy prior to treatment was administered to 10 men.  Post-HIFU with a minimum 6 months follow up (mean 10.62 months), 2% (1/59) of men had de novo moderate to severe erectile dysfunction (IIEF ≤ 11).  With a minimum of 6 months follow up (mean 8.85 months), 17% (7/41) of the men had significant incontinence according to their EPIC scores.  Early complications included catheter-related problems (n = 10), retention (n = 16), and urosepsis (n = 1).  Late complications included need for cystoscopy (n = 25), TURP (n = 6), VIU/dilatation for stricture or bladder neck contracture (n = 13) and self-catheterization (n = 1).  Prostatorectal fistula occurred in one patient who had prior radiotherapy.  Salvage HIFU following radiation failure was performed in seven men.  Recurrence of cancer following HIFU was diagnosed in seven men.  Salvage treatment included radical prostatectomy (n = 3), radiation therapy (n = 2), repeat HIFU (n = 1), hormone therapy (n = 1).
  
  
  CONCLUSIONS
  In our early experience HIFU treatment for prostate cancer was associated with a moderate rate of complications and failure.  Further studies are required to examine long term outcomes with HIFU.
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Dean S
authors.initials: DS
authors.lastname: Elterman
authors.forename: Jack
authors.initials: J
authors.lastname: Barkin
authors.forename: Sidney B
authors.initials: SB
authors.lastname: Radomski
authors.forename: Neil E
authors.initials: NE
authors.lastname: Fleshner
authors.forename: Brian
authors.initials: B
authors.lastname: Liu
authors.forename: Kira
authors.initials: K
authors.lastname: Bensimon
authors.forename: Samantha
authors.initials: S
authors.lastname: Arora
authors.forename: Michael
authors.initials: M
authors.lastname: Robinette
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009864:Ontario; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000379:methods*; D014481:United States / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen