Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan.
Int J Urol. 2011 May;18(5):358-62. doi: 10.1111/j.1442-2042.2011.02739.x. Epub 2011 Mar 30.
To assess the long-term outcomes of transrectal high-intensity focused ultrasound (HIFU) for patients with localized prostate cancer.
From May 2003 to present, 137 consecutive patients with T1-2 prostate cancer were treated using the Sonablate 500 and then followed for more than 12 months after their last HIFU treatment. A prostate biopsy was routinely carried out at 6 months and serum prostate-specific antigen (PSA) was measured every 3 months after HIFU. Oncological outcomes as well as treatment-related complications were assessed. Disease-free survival (DFS) was judged using the Phoenix definition (PSA nadir + 2 ng/mL), negative histological findings and no local or distant metastasis.
The median follow up after HIFU was 36 months (range 12-84 months). No patients received adjuvant therapy during this period. The PSA nadir occurred at 2 months after HIFU and the median level was 0.07 ng/mL (0.01-2.01 ng/mL). Of the 133 patients who underwent prostate biopsy or transurethral resection of the prostate at 6 months or later after HIFU, six were positive for cancer cells (4.5%). There were no major postoperative complications, but urge incontinence (16 cases) and dysuria (33 cases) occurred after removal of the urethral catheter. The 5-year DFS rate was 78% based on these criteria, and 91%, 81% and 62% in the low-, intermediate- and high-risk group, respectively.
HIFU represents an effective, repeatable and minimally invasive treatment. It is particularly effective for low- and intermediate-risk patients, and it should be considered as an option for localized prostate cancer.
评估经直肠高强度聚焦超声（HIFU）治疗局限性前列腺癌患者的长期疗效。
自 2003 年 5 月至今，对 137 例 T1-2 期前列腺癌患者采用 Sonablate 500 进行治疗，在最后一次 HIFU 治疗后随访时间超过 12 个月。HIFU 后 6 个月常规进行前列腺活检，每 3 个月检测血清前列腺特异抗原（PSA）。评估肿瘤学疗效及治疗相关并发症。无病生存（DFS）采用 Phoenix 定义（PSA 最低值+2ng/ml、组织学阴性且无局部或远处转移）进行判断。
HIFU 后中位随访时间为 36 个月（12-84 个月）。在此期间，无患者接受辅助治疗。PSA 最低值出现在 HIFU 后 2 个月，中位数为 0.07ng/ml（0.01-2.01ng/ml）。在 HIFU 后 6 个月或以后进行前列腺活检或经尿道前列腺切除术的 133 例患者中，有 6 例（4.5%）前列腺组织中发现癌细胞。无重大术后并发症，但在拔除尿道导管后有 16 例发生急迫性尿失禁和 33 例发生排尿困难。根据这些标准，5 年 DFS 率为 78%，低危、中危和高危组分别为 91%、81%和 62%。
HIFU 是一种有效、可重复和微创的治疗方法。它对低危和中危患者特别有效，可作为局限性前列腺癌的一种治疗选择。
