Elterman Dean S, Barkin Jack, Radomski Sidney B, Fleshner Neil E, Liu Brian, Bensimon Kira, Arora Samantha, Robinette Michael, Finelli Antonio
Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Can J Urol. 2011 Dec;18(6):6037-42.
High intensity focused ultrasound (HIFU) is a non-invasive technique that uses focused ultrasound waves to ablate tissue. This retrospective study evaluates the early HIFU experience at a single Canadian center.
Ninety-five patients were treated between March 2006 and December 2007 using the Sonablate-500 device (Focus Surgery, Indianapolis, IN, USA). Follow up occurred at 3 month intervals and included serial prostate-specific antigen (PSA) measurements, assessments of erectile function and continence rates with the international index of erectile function (IIEF) and expanded prostate cancer index composite (EPIC) questionnaires respectively. Early and late complications were also studied.
There were 95 patients treated by five urologists. The mean age of patients was 64 years (range 46-91). The majority of men treated had Gleason 6 (n = 53) or Gleason 7 (n = 35) disease. The remainder had Gleason 8 (n = 5) and Gleason 9 (n = 2) prostate cancer. Prostate volume in the pre-treatment group was 30.5 cc (range 14.4 cc-73 cc). Cytoreductive androgen deprivation therapy prior to treatment was administered to 10 men. Post-HIFU with a minimum 6 months follow up (mean 10.62 months), 2% (1/59) of men had de novo moderate to severe erectile dysfunction (IIEF ≤ 11). With a minimum of 6 months follow up (mean 8.85 months), 17% (7/41) of the men had significant incontinence according to their EPIC scores. Early complications included catheter-related problems (n = 10), retention (n = 16), and urosepsis (n = 1). Late complications included need for cystoscopy (n = 25), TURP (n = 6), VIU/dilatation for stricture or bladder neck contracture (n = 13) and self-catheterization (n = 1). Prostatorectal fistula occurred in one patient who had prior radiotherapy. Salvage HIFU following radiation failure was performed in seven men. Recurrence of cancer following HIFU was diagnosed in seven men. Salvage treatment included radical prostatectomy (n = 3), radiation therapy (n = 2), repeat HIFU (n = 1), hormone therapy (n = 1).
In our early experience HIFU treatment for prostate cancer was associated with a moderate rate of complications and failure. Further studies are required to examine long term outcomes with HIFU.
高强度聚焦超声（HIFU）是一种利用聚焦超声波消融组织的非侵入性技术。本回顾性研究评估了加拿大一家单一中心早期使用HIFU的经验。
2006年3月至2007年12月期间，95例患者使用Sonablate - 500设备（美国印第安纳波利斯市焦点外科公司）进行治疗。随访每隔3个月进行一次，包括连续检测前列腺特异性抗原（PSA），分别使用国际勃起功能指数（IIEF）和扩展前列腺癌指数综合问卷（EPIC）评估勃起功能和控尿率。同时也研究了早期和晚期并发症。
5位泌尿外科医生共治疗了95例患者。患者的平均年龄为64岁（范围46 - 91岁）。接受治疗的大多数男性患有Gleason 6（n = 53）或Gleason 7（n = 35）疾病。其余患者患有Gleason 8（n = 5）和Gleason 9（n = 2）前列腺癌。治疗前组前列腺体积为30.5立方厘米（范围14.4立方厘米 - 73立方厘米）。10名男性在治疗前接受了减瘤雄激素剥夺治疗。HIFU治疗后至少随访6个月（平均10.62个月），2%（1/59）的男性出现新发中度至重度勃起功能障碍（IIEF≤11）。至少随访6个月（平均8.85个月）时，根据EPIC评分，17%（7/41）的男性出现明显尿失禁。早期并发症包括导管相关问题（n = 10）、潴留（n = 16）和尿脓毒症（n = 1）。晚期并发症包括需要膀胱镜检查（n = 25）、经尿道前列腺切除术（n = 6）、因狭窄或膀胱颈挛缩进行尿道内切开术/扩张术（n = 13）和自我导尿（n = 1）。1例曾接受放疗的患者发生了前列腺直肠瘘。7名男性在放疗失败后接受了挽救性HIFU治疗。7名男性被诊断为HIFU治疗后癌症复发。挽救性治疗包括根治性前列腺切除术（n = 3）、放射治疗（n = 2）、重复HIFU（n = 1）、激素治疗（n = 1）。
在我们的早期经验中，HIFU治疗前列腺癌与中度并发症发生率和失败率相关。需要进一步研究来检验HIFU的长期疗效。
