High-Intensity Focused Ultrasound Effective Against High-Risk Prostate Cancer

By Will Boggs, MD

NEW YORK JAN 15, 2007 (Reuters Health) - High-intensity focused ultrasound (HIFU) safely provides favorable short-term outcomes in men with high-risk prostate cancer, according to a report in the December 2006 issue of BJU International.

"HIFU is based on a focused form of energy providing higher safety and precision than divergent energies (cryotherapy, radiotherapy)," Dr. Vincenzo Ficarra from the University of Verona, Italy told Reuters Health. "In patients with a high risk for progression or with locally advanced disease, this treatment might represent a valid alternative to radiotherapy."

Dr. Ficarra and colleagues investigated the short-term outcome of HIFU treatment in 30 patients with high-risk prostate cancer who had all previously undergone transurethral resection of the prostate. HIFU was administered under general anesthesia, and they received concomitant hormonal therapy. 

No complications were reported during HIFU, which required a median overall duration of 140 minutes to produce a median 750 lesions, the authors report. The mean hospital stay was 2.2 days.

Symptomatic lower urinary tract infections were reported in 5 patients during the first year, the results indicate, and 3 patients experienced urethral stenoses that were treated by cold-knife incision and subsequent urethral calibration.

Three months after HIFU, 25 patients had complete urinary continence, the researchers note, and all but 2 patients (78 and 79 years old) were continent after 12 months.

Six months after HIFU, the median prostate volume was significantly lower than the baseline value, the report indicates. Sextant prostate biopsy was positive in 7 patients (23%), including 4 with one positive core and 3 with two positive cores.

None of the patients had PSA values above 1.0 ng/mL at 1 year, the investigators say, and only 3 patients (all of whom had two positive cores at the 6-month sextant prostate biopsy) had PSA values above 0.3 ng/mL.

"In case of biochemical or clinical persistence or recurrence, it is possible to repeat HIFU local treatment," Dr. Ficarra said. "In this case, it is necessary to inform the patient that perioperative complication rates could be higher than those at the first treatment."

"I would like to emphasize the low invasiveness of this kind of treatment, the short in-hospital stay, and the possibility to further improve the software of the device," Dr. Ficarra said.

"Future studies will evaluate long-term oncological results, still lacking in current literature," Dr. Ficarra added. "As previous studies, they will be based on the association of HIFU with LHRH analogues."

SOURCE:

• BJU International 2006;98:1193-1198.