High-intensity focused ultrasound for the treatment of prostate cancer: A prospective trial with long-term follow-up

Luigi Mearini, Leonardo D'Urso, Devis Collura, Elisabetta Nunzi, Giovanni Muto, Massimo Porena

Research output: Contribution to journalArticle

Abstract

Objective. High-intensity focused ultrasound (HIFU) is a minimally invasive treatment for prostate cancer. Data from the literature show promising oncological outcomes with a favourable side-effect profile. The aim of this study was to re-evaluate and bring up to date the follow-up of a previously published, prospective trial on HIFU as the primary treatment for prostate cancer. Materials and methods. Between 2004 and 2007, 163 consecutive men with T1-T3N0M0 prostate cancer underwent HIFU with the Sonablate® 500. Follow-up included prostate-specific antigen (PSA) tests every 3 months after treatment and a random prostate biopsy at 6 months. Failure was defined according to positive findings at the 6 month biopsy and biochemical failure was defined according to the Phoenix criteria. Biochemical-free survival, metastasis-free survival and cancer-specific survival were calculated by Kaplan-Meier curves. Results. Median follow-up was 72.0 months. Of the 160 evaluable patients, 104 (65%) were biochemically disease free; in low- to intermediate-risk disease, on Kaplan-Meier analysis the 8 year biochemical-non-evidence of disease (bNED), metastasis-free survival and cancer-specific survival rates were 69.6%, 81.3%, 100% and 40.5%, 60.6%, 100%, respectively. A PSA nadir below 0.40 ng/ml and risk stratification have an independent predictive value for bNED and metastasis-free survival. Conclusions. A long-term favourable outcome of HIFU is associated with careful patient selection, with low- to intermediate-risk disease being the ideal case. A low postoperative PSA nadir is a predictor of long-term bNED.

Original languageEnglish
Pages (from-to)267-274
Number of pages8
JournalScandinavian Journal of Urology
Volume49
Issue number4
DOIs
Publication statusPublished - Aug 1 2015

Fingerprint

Prostatic Neoplasms
Prostate-Specific Antigen
Neoplasm Metastasis
Disease-Free Survival
Survival
Biopsy
Kaplan-Meier Estimate
Therapeutics
Patient Selection
Prostate
Neoplasms
Survival Rate

Keywords

  • Biochemical-free survival
  • Cancer-specific survival
  • HIFU
  • High-intensity focused ultrasound
  • Prostate cancer

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

High-intensity focused ultrasound for the treatment of prostate cancer : A prospective trial with long-term follow-up. / Mearini, Luigi; D'Urso, Leonardo; Collura, Devis; Nunzi, Elisabetta; Muto, Giovanni; Porena, Massimo.

In: Scandinavian Journal of Urology, Vol. 49, No. 4, 01.08.2015, p. 267-274.

Research output: Contribution to journalArticle

Mearini, Luigi ; D'Urso, Leonardo ; Collura, Devis ; Nunzi, Elisabetta ; Muto, Giovanni ; Porena, Massimo. / High-intensity focused ultrasound for the treatment of prostate cancer : A prospective trial with long-term follow-up. In: Scandinavian Journal of Urology. 2015 ; Vol. 49, No. 4. pp. 267-274.
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N2 - Objective. High-intensity focused ultrasound (HIFU) is a minimally invasive treatment for prostate cancer. Data from the literature show promising oncological outcomes with a favourable side-effect profile. The aim of this study was to re-evaluate and bring up to date the follow-up of a previously published, prospective trial on HIFU as the primary treatment for prostate cancer. Materials and methods. Between 2004 and 2007, 163 consecutive men with T1-T3N0M0 prostate cancer underwent HIFU with the Sonablate® 500. Follow-up included prostate-specific antigen (PSA) tests every 3 months after treatment and a random prostate biopsy at 6 months. Failure was defined according to positive findings at the 6 month biopsy and biochemical failure was defined according to the Phoenix criteria. Biochemical-free survival, metastasis-free survival and cancer-specific survival were calculated by Kaplan-Meier curves. Results. Median follow-up was 72.0 months. Of the 160 evaluable patients, 104 (65%) were biochemically disease free; in low- to intermediate-risk disease, on Kaplan-Meier analysis the 8 year biochemical-non-evidence of disease (bNED), metastasis-free survival and cancer-specific survival rates were 69.6%, 81.3%, 100% and 40.5%, 60.6%, 100%, respectively. A PSA nadir below 0.40 ng/ml and risk stratification have an independent predictive value for bNED and metastasis-free survival. Conclusions. A long-term favourable outcome of HIFU is associated with careful patient selection, with low- to intermediate-risk disease being the ideal case. A low postoperative PSA nadir is a predictor of long-term bNED.

AB - Objective. High-intensity focused ultrasound (HIFU) is a minimally invasive treatment for prostate cancer. Data from the literature show promising oncological outcomes with a favourable side-effect profile. The aim of this study was to re-evaluate and bring up to date the follow-up of a previously published, prospective trial on HIFU as the primary treatment for prostate cancer. Materials and methods. Between 2004 and 2007, 163 consecutive men with T1-T3N0M0 prostate cancer underwent HIFU with the Sonablate® 500. Follow-up included prostate-specific antigen (PSA) tests every 3 months after treatment and a random prostate biopsy at 6 months. Failure was defined according to positive findings at the 6 month biopsy and biochemical failure was defined according to the Phoenix criteria. Biochemical-free survival, metastasis-free survival and cancer-specific survival were calculated by Kaplan-Meier curves. Results. Median follow-up was 72.0 months. Of the 160 evaluable patients, 104 (65%) were biochemically disease free; in low- to intermediate-risk disease, on Kaplan-Meier analysis the 8 year biochemical-non-evidence of disease (bNED), metastasis-free survival and cancer-specific survival rates were 69.6%, 81.3%, 100% and 40.5%, 60.6%, 100%, respectively. A PSA nadir below 0.40 ng/ml and risk stratification have an independent predictive value for bNED and metastasis-free survival. Conclusions. A long-term favourable outcome of HIFU is associated with careful patient selection, with low- to intermediate-risk disease being the ideal case. A low postoperative PSA nadir is a predictor of long-term bNED.

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