Transrectal High Intensity Focused Ultrasound for the Treatment of Localized Prostate Cancer: Factors Influencing the OutcomeGelet A.a,b · Chapelon J.Y.b · Bouvier R.a · Rouvière O.a · Lyonnet D.a · Dubernard J.M.a,b
aUrology Department, Edouard Herriot Hospital, and bINSERM Unit 281, Lyon, France
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Objectives: Efficacy evaluation of high intensity focused ultrasound (HIFU) treatment for localized prostate cancer and identification of the factors affecting the outcome. Patients and Methods: 102 patients with prostate cancer stage T1–T2 and noncandidates for radical prostatectomy have been treated with HIFU (Ablatherm™, EDAP–Technomed). The disease progression (failure) was strictly defined by any positive sample at control biopsies, whatever the prostate–specific antigen (PSA) level, or by 3 consecutive increases in PSA levels in case of negative biopsies. Results: At inclusion, patients’ baseline characteristics were (mean ± standard deviation): age 70.8 (±6.13) years, PSA 8.38 (±4.8) ng/ml, prostate volume 33.3 (±16.71) cm3. The population mean follow–up was 19 months (3–76 months). The overall success rate was 66%. Statistically significant variations of the overall success with a more favorable outcome were observed when (1) the initial PSA level was ≤10 ng/ml (73 vs. 50%, p = 0.02), (2) the Gleason score was ≤6 (81 vs. 46%, p<0.001) and (3) the pretreatment sextant biopsy evidenced 1–4 positive samples (68 vs. 40%, p = 0.01). Conclusion: Results observed after HIFU treatment in localized prostate cancer are now challenging those obtained after radiation therapy. The success rate is influenced by disease–related prognostic factors.
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