Abstract
Background and Purpose:
Criteria for determining the durability of the response to transrectal high-intensity focused ultrasound (HIFU) ablation of prostate cancer have been established by calculating progression-free probability.
Patients and Methods:
A series of 82 patients (mean age 71 ± 5.7 years) with biopsy-proven localized (stage T1-T2) cancer who were not suitable candidates for radical surgery underwent transfectal HIFU ablation with the AblathermTM machine. The mean follow-up was 17.6 months (range 3-68 months). The mean serum prostate specific antigen (PSA) value and mean prostate volume were 8.11 ± 4.64 ng/mL and 34.9 ± 17.4 cm3, respectively. Progression was rigidly defined as any positive biopsy result, regardless of PSA concentration, or three successive PSA increases for patients with a negative biopsy (PSA velocity ≥ 0.75). Times to specific events (positive biopsy and PSA elevation) were analyzed with the Kaplan-Meier survival method.
Results:
Overall, 62% of the patients exhibited no evidence of disease progression 60 months after transrectal HIFU ablation. In particular, the disease-free rate was 68% for the moderate-risk group of 50 patients (PSA <15.0 ng/mL, Gleason sum <8, prostate volume <40 cm3, and number of positive biopsies <5). For the low-risk group of 32 patients (PSA < 10 ng/mL and Gleason sum <7), the disease-free survival rate was 83%.
Conclusion:
Transrectal HIFU prostate ablation is an effective therapeutic alternative for patients with localized prostatic adenocarcinoma.
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