Transrectal high intensity focused ultrasound for the treatment of localized prostate cancer: Factors influencing the outcome

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 non candidates for radical prostatectomy have been treated with HIFU (Ablatherm (TM), EDAP-Technomed). The disease progression (failure) was strictly defi ned by any positive sample at control biopsies, whatever the prostate-speci fic antigen (PSA) level, or by 3 consecutive increases in PSA levels in cas e of negative biopsies. Results: At inclusion, patients' baseline characteristics were (mean standa rd deviation): age 70.8 (+/-6.13) years, PSA 8.38 (+/-4.8) ng/ml, prostate volume 33.3 (+/- 16.71) cm(3). 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 observ ed when (1) the initial PSA level was less than or equal to 10 ng/ml (73 vs . 50%, p = 0.02), (2) the Gleason score was less than or equal to6 (81 vs. 46%, p < 0.001) and (3) the pretreatment sextant biopsy evidenced 1-4 posit ive samples (68 vs. 40%, p = 0.01). Conclusion: Results observed after HIFU treatment in localized prostate can cer are now challenging those obtained after radiation therapy. The success rate is influenced by disease-related prognostic factors. Copyright (C) 20 01 S. Karger AG, Basel.