title: Single session of high-intensity focused ultrasound for localized prostate cancer: treatment outcomes and potential effect as a primary therapy.
abstract: OBJECTIVE
  To investigate the treatment outcomes of a single-session high-intensity focused ultrasound (HIFU) using the Sonablate(®) for patients with localized prostate cancer.
  
  
  METHODS
  Biochemical failure was defined according to the Stuttgart definition [a rise of 1.2 ng/ml or more above the nadir prostate-specific antigen (PSA)] and the Phoenix definition (a rise of 2 ng/ml or more above the nadir PSA). Disease-free survival rate was defined using the Phoenix criteria and positive follow-up biopsy.
  
  
  RESULTS
  A total of 171 patients were identified. Fifty-two (30.4 %) patients were identified to be with D'Amico low risk, 47 (27.5 %) with intermediate risk, and 72 (42.1 %) with high risk. In the median follow-up time of 43 months, there was 44 (25.7 %) and 36 (21.1 %) patients experienced biochemical failure for Stuttgart and Phoenix definition with mean (±SD) time to failure of 17.8 ± 2.1 and 19.4 ± 2.3 months, respectively. A total of 44 (25.7 %) patients were diagnosed as disease failure. Cox multivariate analysis revealed PSA nadir level (PSA cutoff = 0.2 ng/ml; HR = 9.472, 95 % CI 4.527-19.820, p < 0.001) and D'amico risk groups [HR = 3.132 (95 % CI 1.251-6.389), p = 0.033] were the predictor for failure in single-session HIFU.
  
  
  CONCLUSIONS
  Single-session HIFU treatment using the Sonablate(®) seems to be potentially curative approach. When treated carefully with neoadjuvant hormonal therapy or preoperative transurethral resection of the prostate, higher-risk disease might be able to choose this minimally invasive procedure as primary therapy.
authors.affiliation: Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan, uro051@poh.osaka-med.ac.jp.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Komura
authors.forename: Teruo
authors.initials: T
authors.lastname: Inamoto
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Takai
authors.forename: Taizo
authors.initials: T
authors.lastname: Uchimoto
authors.forename: Kenkichi
authors.initials: K
authors.lastname: Saito
authors.forename: Naoki
authors.initials: N
authors.lastname: Tanda
authors.forename: Junko
authors.initials: J
authors.lastname: Kono
authors.forename: Koichiro
authors.initials: K
authors.lastname: Minami
authors.forename: Hirohumi
authors.initials: H
authors.lastname: Uehara
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Fujisue
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Takahara
authors.forename: Hajime
authors.initials: H
authors.lastname: Hirano
authors.forename: Hayahito
authors.initials: H
authors.lastname: Nomi
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Watsuji
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kiyama
authors.forename: Haruhito
authors.initials: H
authors.lastname: Azuma
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000379:methods