title: [High-intensity focussed ultrasound in low-risk prostate cancer - oncological outcome and postinterventional quality of life of an inexperienced therapy centre in comparison with an experienced therapy centre].
abstract: BACKGROUND
  In patients with low-risk prostate cancer (PCa) the standard therapies carry a risk of overtreatment with potentially preventable side effects whereas restrained therapeutic strategies pose a risk of underestimation of the individual cancer risk. Alternative treatment options include thermal ablation strategies such as high-intensity focused ultrasound (HIFU).
  
  
  METHODS
  96 patients with low-risk PCa (D'Amico) were treated at 2 HIFU centres with different expertise (n=48, experienced centre Lyon/France; n=48 inexperienced centre Charité Berlin/Germany). Matched pairs were formed and analysed with regard to biochemical disease-free survival (BDFS) as well as postoperative functional parameters (micturition, erectile function). The matched pairs were discriminated as to whether they had received HIFU treatment alone or a combination of HIFU with transurethral resection of the prostate (TURP). Patients of the Lyon group were retrospectively matched through the @-registry database whereas patients of the Berlin group were prospectively evaluated. In the latter patients quality of life assessment was additionally inquired.
  
  
  RESULTS
  Postoperative PSA-Nadir was lower in the Berlin group for patients with HIFU only (0.007 vs. Lyon 0.34 ng/ml; p=0.037) and HIFU+TURP (0.25 vs. Lyon 0.42 ng/ml; p=0.003). BDFS was comparable in both groups for HIFU only (Berlin 4.77, Lyon 5.23 years; p=0.741) but patients with combined HIFU+TURP in the Berlin group showed an unfavourable BDFS as compared to the Lyon group (Berlin 3.02, Lyon 4.59 years; p=0.05). In an analysis of Berlin subgroups especially patients who had received HIFU and TURP (n=4) within the same narcosis had an unfavourable BDFS (p=0.009). Median follow-up was 3.36 years for HIFU only and 2.26 years for HIFU+TURP. Neither HIFU only (p=0.117) nor HIFU+TURP (p=0.131) showed an impact on postoperative micturition. Erectile function was negatively influenced (HIFU: p=0.04; HIFU+TURP: p=0.036). There was no measurable change in quality of life after the treatment.
  
  
  CONCLUSIONS
  The 4-year BDFS after HIFU and HIFU+TURP is comparable to that of the standard therapies. The erectile function is sustainably negatively influenced whereas postoperative micturition and quality of life were not affected by HIFU or HIFU+TURP. These results are strongly limited by the low patient count and the short follow-up period and require validation in prospective multicentre studies with higher number of cases.
authors.affiliation: Klinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg. daniel.baumunk@med.ovgu.de
authors.forename: D
authors.initials: D
authors.lastname: Baumunk
authors.forename: C
authors.initials: C
authors.lastname: Andersen
authors.forename: U
authors.initials: U
authors.lastname: Heile
authors.forename: J
authors.initials: J
authors.lastname: Ebbing
authors.forename: H
authors.initials: H
authors.lastname: Cash
authors.forename: M
authors.initials: M
authors.lastname: Porsch
authors.forename: U-B
authors.initials: UB
authors.lastname: Liehr
authors.forename: A
authors.initials: A
authors.lastname: Janitzky
authors.forename: J J
authors.initials: JJ
authors.lastname: Wendler
authors.forename: D
authors.initials: D
authors.lastname: Schindele
authors.forename: S
authors.initials: S
authors.lastname: Blaschke
authors.forename: K
authors.initials: K
authors.lastname: Miller
authors.forename: M
authors.initials: M
authors.lastname: Schostak
mesh_terms: D000368:Aged; D001604:Berlin; D014408:Biomarkers, Tumor / Q000097:blood; D002983:Clinical Competence; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005602:France; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D053208:Kaplan-Meier Estimate; D059032:Learning Curve; D008297:Male; D016555:Matched-Pair Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D020728:Transurethral Resection of Prostate; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen