title: Experience with high-intensity focused ultrasound therapy for management of organ-confined prostate cancer: critical evaluation of oncologic outcomes.
abstract: OBJECTIVE
  To assess the oncologic results of high-intensity focused ultrasound therapy (HIFU) as treatment for clinically localized prostate cancer.
  
  
  METHODS
  A total of 180 patients with clinically localized prostate cancer underwent HIFU and were retrospectively reviewed. Of those 171 patients primarily treated with HIFU were included in the analysis. They were stratified by prostatic volume, neoadjuvant hormonal ablation (NHA), and post-treatment PSA nadir. PSA level was monitored every month during the first 6 months after the treatment and every 3 months thereafter. According to the latest Phoenix criteria, biochemical failure was defined by a PSA rise of2 ng/ml or more above the PSA nadir. Seventy-six (44.4%) patients were offered preoperative NHA in median duration of 3 months (IQR: 3-5.75). Preoperative transurethral resection of the prostate (TURP) was performed in 56 (32.7%) patients having the calcification within the prostatic gland.
  
  
  RESULTS
  Mean patient age was 68.3 +/- 7.0. The median follow-up time was 43 months (IQR: 30-55). According to D'amico risk groups 52 (30.4%) patients were identified with low risk, 47 (27.5%) patients with intermediate risk, and 72 (42.1%) with high risk. The overall and cancer-specific survival rates at 5 years were 98.8% and 100%. The metastasis-free survival rate at 5 years was 99.4%. No significant differences were seen in biochemical failure-free survival when stratified according to preoperative prostatic volume and administration of preoperative NHA (p = 0.931 and p = 0.712, respectively). Regardless NHA administration, patients with smaller PSA nadir (0.2 ng/ml) achieved better biochemical failure-free survival ratio.
  
  
  CONCLUSIONS
  High-intensity focused ultrasound therapy provides sufficient oncologic control only in patients with low-risk prostate cancer. However, our data could be used to improve the selection of patients who are potential candidates for HIFU therapy.
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: Hiroshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Watsuji
authors.forename: Harubito
authors.initials: H
authors.lastname: Azuma
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D017430:Prostate-Specific Antigen