title: Urethra-sparing high-intensity focused ultrasound for localized prostate cancer: Functional and oncological outcomes.
abstract: OBJECTIVE
  To evaluate longitudinal changes in urinary function and quality of life, and the oncological outcomes of patients treated with urethra-sparing high-intensity focused ultrasound for localized prostate cancer.
  
  
  METHODS
  Patients with negative findings in the urethra and the anterior urethral zone using transrectal ultrasound-guided targeted biopsies, and magnetic resonance imaging, received urethra-sparing or whole-gland high-intensity focused ultrasound as the primary therapy for localized prostate cancer without transurethral resection of the prostate. Longitudinal changes in urinary function and quality of life, and the oncological outcomes of the patients were analyzed retrospectively.
  
  
  RESULTS
  The median follow-up times for urethra-sparing and whole-gland high-intensity focused ultrasound were 36 and 30 months, respectively. Comparing the patients treated with urethra-sparing high-intensity focused ultrasound (n = 45) with those treated with whole-gland high-intensity focused ultrasound (n = 65), there were significant differences in the International Prostate Symptom Score (P = 0.014) at 3 months, International Prostate Symptom Score quality of life (P = 0.033) at 3 months, maximum urinary flow rate (mL/s; at 3 months, P = 0.010; at 6 months, P = 0.038) and residual urine volume (mL; at 3 months, P < 0.0001; at 6 months, P = 0.016; at 12 months, P = 0.028). For quality of life, there were significant differences in Functional Assessment of Cancer Therapy - General (at 3 months, P = 0.022) and Functional Assessment of Cancer Therapy - Prostate (at 3 months, P = 0.028; at 6 months, P = 0.034). There were no significant differences in oncological outcomes regarding negative biopsy rates on follow up (91% vs 92%; P = 0.8) or biochemical disease-free survival rates (86.7% vs 89.2%; P = 0.7).
  
  
  CONCLUSIONS
  Urethra-sparing high-intensity focused ultrasound might prevent prolonged bladder outlet obstruction, and could be a treatment option for localized prostate cancer.
authors.affiliation: Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Shoji
authors.affiliation: Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Mayura
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujikawa
authors.affiliation: Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Endo
authors.affiliation: Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Hashimoto
authors.affiliation: Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Tomonaga
authors.affiliation: Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Terachi
authors.affiliation: Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D011183:Postoperative Complications; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal; D014521:Urethra / Q000473:pathology*; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*
chemical_list: D017430:Prostate-Specific Antigen
keywords: high-intensity focused ultrasound; localized prostate cancer; tailor-made treatment; urethra-sparing; urinary function