High-intensity focused ultrasound for localized prostate Cancer in Cathay General Hospital

Shu-Wei Tsai; Teh-Sheng Hsieh

doi:10.4103/JCRP.JCRP_13_18

ORIGINAL ARTICLE

Year : 2019 | Volume : 6 | Issue : 2 | Page : 64-67

High-intensity focused ultrasound for localized prostate Cancer in Cathay General Hospital

Shu-Wei Tsai, Teh-Sheng Hsieh
Division of Urology, Department of Surgery, Cathay General Hospital, Taipei; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan

Date of Submission	29-Jun-2018
Date of Decision	06-Nov-2018
Date of Acceptance	28-Dec-2018
Date of Web Publication	31-May-2019

Correspondence Address:
Dr. Shu-Wei Tsai
Division of Urology, Department of Surgery, Cathay General Hospital, No. 280 Renai Rd., Sec. 4, Taipei
Taiwan

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JCRP.JCRP_13_18

Abstract

Purpose: The purpose of this study is to report our results regarding the use of transrectal high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Materials and Methods: From January 2012 to January 2017, 57 patients with localized prostate cancer (cT1c-T2cN0M0) were treated with an Ablatherm™ HIFU device. Of these patients, we excluded those with <12 months of follow-up. In total, 33 patients with localized prostate cancer were enrolled in this study. We assessed the efficacy according to posttreatment prostate-specific antigen (PSA) levels and complications. PSA levels were monitored immediately after HIFU therapy as well as every 3 months thereafter. Biochemical failure was defined as an increase in PSA of 2 ng/mL or more above the PSA nadir. Result: The mean age of all patients was 69.12 ± 8.21 (range: 49–80) years,and the average pretreatment PSA level was 15.19 ± 12.89 (range: 4.44–62.91) ng/mL. The Gleason score ranged from 6 (3 + 3) to 9 (4 + 5) and the mean prostate volume was 38.72 ± 17.90 (range: 21–77) mL. The mean follow-up duration was 36.4 ± 10.8 (range: 13–60) months.Ten patients were classified as low risk, 10 patients were classified as intermittent risk, and 13 patients were classified as high risk according to the National Comprehensive Cancer Network guidelines regarding the risk of recurrence. The PSA levels of all patients decreased significantly after HIFU therapy, and an undetectable PSA (0.04 ng/mL) level was observed in four patients (12.12%). The posttreatment mean PSA nadir was 0.609 ± 0.91 (range: 3.21–0.04) ng/mL, and the mean follow-up duration was 3.1 ± 1.9 (range: 1–8) months. The survival rate was 100%. The PSA biochemical failure rate was 27.3% (9/33). Posttreatment complications included urge incontinence (3/33), total urinary incontinence (0/33), bladder neck contracture (5/33), and urethral stricture (1/33). Conclusion: HIFU therapy appeared to be an effective minimally invasive therapy with acceptable complication rate in selected localized prostate cancer patients.

Keywords: High-intensity focused ultrasound, localized, prostate, prostate cancer High-intensity focused ultrasound, localized, prostate, prostate cancer

How to cite this article:
Tsai SW, Hsieh TS. High-intensity focused ultrasound for localized prostate Cancer in Cathay General Hospital. J Cancer Res Pract 2019;6:64-7

How to cite this URL:
Tsai SW, Hsieh TS. High-intensity focused ultrasound for localized prostate Cancer in Cathay General Hospital. J Cancer Res Pract [serial online] 2019 [cited 2023 Mar 31];6:64-7. Available from: https://www.ejcrp.org/text.asp?2019/6/2/64/259484

Introduction

Prostate cancer is common in the United States and many other Western countries, but it is not prevalent in Asian countries.^[1],[2] However, according to data from the Taiwan Cancer Registry, the incidence of prostate cancer has been increasing annually since 2009, and it is presently the fifth most prevalent cancer in Taiwan.^[3] Therefore, prostate cancer is a crucial health concern in Taiwan.

Due to the increased use of prostate-specific antigen (PSA) testing and increasing life expectancy, more men are being diagnosed with localized, low-grade prostate cancer. According to the European Association of Urology guidelines, such patients can be managed using radical prostatectomy (RP) or radiotherapy (RT).^[4] However, these established therapies are associated with significant complications and risks (impotency and incontinence). Moreover, some patients are unwilling or unfit for RP or RT (e.g., because of age or comorbidities).

High-intensity focused ultrasound (HIFU) is a promising modality for treating tumors in a complete, minimally invasive fashion. With this treatment, magnetic resonance imaging or diagnostic ultrasound can be used to facilitate online image guidance and therapy control. Numerous reports have indicated that HIFU results in acceptable early-to-medium-term functional and cancer-control outcomes.^[5]

In our series, the posttreatment mean PSA nadir was 0.609 (3.21–0.04) ± 0.91 ng/mL, and the mean follow-up period was 3.1 ± 1.9 (range: 1–8) months. The survival rate was 100%, and the PSA biochemical failure rate was 18.18% (6/33). Posttreatment complications included urge incontinence (3/33), total urinary incontinence (0/33), bladder neck contracture (5/33), and urethral stricture (1/33). We conclude that HIFU treatment is an effective minimally invasive therapy with an acceptable complication rate in selected localized prostate cancer patients.

Materials and Methods

From January 2012 to January 2017, 57 patients with localized prostate cancer (cT1c-T2cN0M0) were treated using an Ablatherm™ HIFU device (EDAP, Lyon, France). Of these patients, we excluded those with <12 months of follow-up. In total, 33 patients with localized prostate cancer were enrolled in this study of HIFU treatment. Transurethral resection of the prostate was performed before HIFU for 8 patients due to a prostate size of more 40 mL.

We assessed the efficacy according to posttreatment PSA levels and complications. For primary treatment, selection was based on the following criteria: cancer localized to the prostate, PSA level, and clinical stage.

PSA levels were monitored immediately following HIFU therapy as well as every 3 months thereafter. Biochemical failure was defined an increase in PSA level of 2 ng/mL or more above the PSA nadir (phoenix definition).^[6] Patient complaints related to HIFU including urge incontinence, total urinary incontinence, bladder neck contracture, urine retention, prostatitis, urethral stricture, and bladder neck contract were recorded.

Results

Between 2012 and 2017, a total of 33 patients were scheduled for HIFU at our hospital. Three patients were lost to follow-up and were thus excluded from this study. The mean age of all patients was 69.12 ± 8.21 (range: 49–80) years, and their average pretreatment PSA level was 15.19 ± 12.89 (range: 4.44–62.91) ng/mL. The Gleason scores ranged from 6 (3 + 3) to 9 (4 + 5), and the mean prostate volume was 38.72 ± 17.9 (range: 21–77) mL. The mean follow-up duration was 36.4 ± 10.8 (range: 13–60) months. Ten patients were classified as low risk, 10 patients were classified as intermittent risk, and 13 patients were classified as high risk, according to the National Comprehensive Cancer Network guidelines regarding the risk of recurrence. The PSA levels of all patients decreased significantly after HIFU therapy, and an undetectable PSA (0.04 ng/mL) level was observed in four patients (12.12%). The posttreatment mean PSA nadir was 0.609 ± 0.91 (range: 3.21–0.04) ng/mL, and the mean duration to PSA nadir was 3.1 ± 1.9 (range: 1–8) months. The survival rate was 100%. The PSA biochemical failure rate was 18.1% (6/33). Posttreatment complications included urge incontinence (3/33), total urinary incontinence (0/33), bladder neck contracture (5/33), and urethral stricture (1/33). The patient characteristics and treatment outcome are summarized in [Table 1] and [Table 2].

Table 1: Patient characteristics

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Table 2: Treatment outcomes

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Six patients who exhibited biochemical failure-received hormone therapy or radiation therapy combined with hormone therapy. After follow-up, the PSA nadir for these patients was 0.82 ± 1.57 ng/mL. These patients continued to receive hormone therapy.

Discussion

The management of localized prostate cancer involves several challenges, particularly with regard to balancing an oncological cure with functional morbidity. The outcomes observed in the present series reflected the key goals for an oncological cure, and urinary continence and erectile function were largely maintained.^[7] HIFU therapy appeared to be an effective minimally invasive therapy for localized prostate cancer, resulting in an acceptable complications rate. HIFU resulted in short-to-medium-term cancer control, and the prevalence of complications was low compared to established therapies. In our series, the overall survival rate was 100%, and the PSA biochemical failure rate was 18.18% (6/33). HIFU appeared to be particularly promising for focal ablation treatment due to the method's precise targeting and low rate of morbidity, as well as the possibility to use magnetic resonance thermography to monitor temperatures in the rectum, urinary sphincter, and neurovascular bundles during treatment.

HIFU is a minimally invasive ablative technology that has emerged as a treatment option for managing localized prostate cancer. Initial reports have suggested that the treatment is associated with low rates of morbidity and good functional results as well as good oncological outcomes.^[8],[9]

A report regarding long-term outcomes among patients who underwent HIFU for localized prostate cancer was published in 2008. Specifically, Blana et al. studied the data of 140 patients treated using an Ablatherm device and who had a mean follow-up of 6.4 years.^[10] Control prostate biopsies were negative in 86.4% of the patients, and the biochemical failure rate was 31.6% based on the Phoenix definition (nadir + 2 ng/mL). [Table 3]^{[9],[10],[11],[12],[13],[14]} and [Table 4]^{[9],[10],[11],[12],[13],[14]} present previously published HIFU outcomes and compliance data.

Table 3: Outcomes in case series of high-intensity focused ultrasound for localized prostate cancer

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Table 4: Complications in case series of high-intensity focused ultrasound for localized prostate cancer

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In our series, we examined the patients' 5-year outcomes following whole-gland HIFU treatment for prostate cancer, and the resultant cancer control was acceptable, with a low risk of urine leakage. However, risks of erectile dysfunction and the need for further operations were similar to other whole-gland treatments such as surgery and RT. In our series, no patients received a prostate biopsy during follow-up.

Conclusion

HIFU is recommended as a minimally invasive low-morbidity ablative treatment for localized prostate cancer. In this study, the efficacy of the treatment was demonstrated. Further studies investigating that the safety and efficacy of HIFU should be conducted based on randomized controlled trials for comparisons with established interventions must be conducted before guidelines regarding the use of HIFU in the management of localized prostate cancer can be established.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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