Single application of high-intensity focused ultrasound as primary therapy of localized prostate cancer: Treatment-related predictors of biochemical outcomes

Asian Journal of Urology, 2015, 2 (1): 46-52 doi:

Original Article

Single application of high-intensity focused ultrasound as primary therapy of localized prostate cancer: Treatment-related predictors of biochemical outcomes

Dietrich Pfeiffer¹, Juergen Berger², Andreas Gross¹

1. Department of Urology, Asklepios Hospital Hamburg-Barmbek, Hamburg, Germany;
2. Center of Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Abstract
Related Citation (15)

Download:

HTML

PDF (433KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective: Recent reports on high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer suggest that preoperative risk groups of tumor recurrence are strong predictors of oncological outcomes. The purpose of this study is to determine the prognostic significance of treatment-related factors in relation to patient characteristics for biochemical outcomes after HIFU. Methods: This retrospective single-center study included patients treated from December 2002 to December 2010 for localized prostate cancer with two generations of Ablatherm^® HIFU devices (A1 and A2). All the patients underwent single HIFU treatment session under the concept of whole-gland therapy. Prostate surgery was performed before HIFU to downsize enlarged glands. Androgen deprivation therapy (ADT) was discontinued before HIFU. Biochemical failure (BCF) was defined as prostate specific antigen (PSA) nadir+1.2 ng/mL (Stuttgart definition). Predictors of BCF were determined using Cox regression models. As covariates, patient-related factors (age, tumor characteristics, ADT) were compared with treatmentrelated factors (prostate volume, HIFU device generation, conduct of therapy, prostate edema, patient movement, anesthetic modalities). Results: Three hundred and twenty-three (98.8%) out of 327 consecutive patients were evaluable for BCF. Median (interquartile range) follow-up was 51.2 (36.6-80.4) months. The overall BCF-rate was 23.8%. In multivariate analyses, higher initial PSA-values (Hazard ratio [HR]: 1.03; p < 0.001) and higher D'Amico risk stages (HR: 3.45; p < 0.001) were patient-related predictors of BCF. Regarding treatment-related factors, the A2 HIFU device was associated with a decreased risk of BCF (HR: 0.51; p=0.007), while prostate edema had an adverse effect (HR: 1.8; p=0.027). Short follow-up and retrospective study design are the primary limitations.

Key words： Prostate cancer High-intensity focused ultrasound Efficacy Biochemical failure Prostate edema Patient movement

Received: 15 July 2014 Published: 06 February 2015

Corresponding Authors: Dietrich Pfeiffer E-mail: d.pfeiffer@asklepios.com

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Dietrich Pfeiffer
	Juergen Berger
	Andreas Gross

TRENDMD:

Cite this article:

Dietrich Pfeiffer,Juergen Berger,Andreas Gross. Single application of high-intensity focused ultrasound as primary therapy of localized prostate cancer: Treatment-related predictors of biochemical outcomes[J]. Asian Journal of Urology, 2015, 2(1): 46-52.

URL:

http://www.ajurology.com/EN/ OR http://www.ajurology.com/EN/Y2015/V2/I1/46

[1]	Gelet A, Chapelon JY, Bouvier R, Souchon R, Pangaud C, Abdelrahim AF, et al. Treatment of prostate cancer with transrectal focused ultrasound: early clinical experience. Eur Urol 1996;29:174-83.
[2]	Crouzet S, Chapelon JY, Rouvie`re O, Mege-Lechevallier F, Colombel M, Tonoli-Catez H, et al. Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. Eur Urol 2014;65:907-14.
[3]	Thüroff S, Chaussy C. Evolution and outcomes of 3 MHz highintensity focused ultrasound for localized prostate cancer during 15 years. J Urol 2013;190:702-10.
[4]	Ganzer R, Fritsche HM, Brandtner A, Bründl J, Koch D, Wieland WF, et al. Fourteen-year oncological and functional outcomes of high-intensity focused ultrasound in localized prostate cancer. BJU Int 2013;112:322-9.
[5]	D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998;280:969-74.
[6]	Blana A, Robertson CN, Brown SC, Chaussy C, Crouzet S, Gelet A, et al. Complete high-intensity focused ultrasound in prostate cancer: outcome from the @-registry. Prostate Cancer Prostatic Dis 2012;15:256-9.
[7]	Ficarra V, Antoniolli SZ, Novara G, Parisi A, Fracalanza S, Martignoni G, et al. Short-term outcome after high-intensity focused ultrasound in the treatment of patients high-risk prostate cancer. BJU Int 2006;98:1193-8.
[8]	Ward JF, Stephen Jones J. Classification system: organ preserving treatment for prostate cancer. Urology 2010;75: 1258-60.
[9]	Pichardo S, Gelet A, Curiel L, Chesnais S, Chapelon JY. New integrated imaging high intensity focused ultrasound probe for transrectal prostate cancer treatment. Ultrasound Med Biol 2008;34:1105-16.
[10]	Cordeiro ER, Cathelineau X, Thüroff, Marberger M, Crouzet S, de la Rosette JJ. High-intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer. BJU Int 2012;110: 1228-42.
[11]	Rewcastle J. High intensity focused ultrasound for prostate cancer: a review of the scientific foundation, technology and clinical outcomes. Technol Cancer Res Treat 2006;5:619-25.
[12]	Rasband WS. ImageJ. Maryland, USA: U. S. National Institutes of Health, Bethesda; 1997-2012. http://imagej.nih.gov/ij/.
[13]	Blana A, Brown SC, Chaussy C, Conti GN, Eastham JA, Ganzer R, et al. High-intensity focused ultrasound for prostate cancer: comparative definitions of biochemical failure. BJU Int 2009;104:1058-62.
[14]	Roach 3rd M, Hanks G, Thames Jr H, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiation therapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006;65:965-74.
[15]	Pfeiffer D, Berger J, Gross AJ. Single application of highintensity focused ultrasound as a first-line therapy for clinically localized prostate cancer: 5-yr outcomes. BJU Int 2012; 110:1702-7.
[16]	Shoji S, Uchida T, Nakamoto M, Kim H, de Castro Abreu AL, Leslie S, et al. Prostate swelling and shift during high intensity focused ultrasound: implication for targeted focal therapy. J Urol 2013;190:1224-32.
[17]	Shabsigh A, Chang DT, Heitjan DF, Kiss A, Olsson CA, Puchner PJ, et al. Rapid reduction in blood flow to the rat ventral prostate gland after castration: preliminary evidence that androgens influence prostate size by regulating blood flow of the prostate gland and prostatic endothelial cell survival. Prostate 1998;36:201-6.
[18]	Wiart M, Curiel L, Gelet A, Lyonnet D, Chapelon JY, Rouvie`re O. Influence of perfusion on high-intensity focused ultrasound prostate ablation: a first-pass MRI study. Magn Reson Med 2007;58:119-27.
[19]	Pinthus JH, Farrokhyar F, Hassouna MM, Woods E, Whelan K, Shayegan B, et al. Single-session primary high-intensity focused ultrasonography treatment for localized prostate cancer: biochemical outcomes using the third generationbased technology. BJU Int 2012;110:1142-8.