Aoun Fouad, Albisinni Simone, Biaou Ibrahim, Peltier Alexandre, Limani Ksenija, Roumeguère Thierry, van Velthoven Roland
Service d'Urologie, Institut Jules-Bordet, Université Libre de Bruxelles, Bruxelles, Belgique; Service d'Urologie, Hôtel Dieu de France, Faculté de médecine - Université Saint-Joseph, Beyrouth, Liban.
Service d'Urologie, Cliniques Universitaires de Bruxelles, hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgique.
Prog Urol. 2019 Oct;29(12):627-633. doi: 10.1016/j.purol.2019.06.004. Epub 2019 Aug 7.
To report the oncological and functional outcomes of salvage hemiablation high-intensity focused ultrasound (HIFU) in patients with unilateral radio-recurrent prostate cancer.
Patients with biochemical recurrence (BCR) after primary radiation therapy and evidence of unilateral organ confined recurrence based on a complete match between mpMRI and MRI targeted biopsies were included. Patients with distant metastasis were excluded. Patients were followed with serial serum PSA determinations. BCR were defined using the Phoenix criteria. Complications were graded according to the Clavien score. IIEF-5 questionnaire was used to assess erectile dysfunction. Urinary incontinence was reported using physician reported rates.
A total of 10 consecutive patients (median age: 71 years, IQR: 69-76) were prospectively enrolled. The median pre-treatment PSA and post-treatment PSA nadir were 3.1ng/mL (IQR: 1.54-8.59) and 1.52ng/mL (IQR: 0.76-2.2), respectively. At a median follow-up of 41.5 (IQR: 18-58) months, 50% of patients experience BCR. BCR free-survival rates at 24 and 36 months were 75% (CI95%: 31-93) and 60% (CI95%: 20-85), respectively. Urinary in continence grade II occurred in two patients and the remaining patients were pad-free. One patient developed de novo erectile dysfunction requiring PDE5I. The erectile function scores decreased from a mean of 10.1 to 8.7.
Hemiablation HIFU is an alternative to whole gland therapy in patients with unilateral radio- recurrent prostate cancer, which offers limited urinary and rectal morbidity, and preserves functional outcomes.
报告挽救性半消融高强度聚焦超声（HIFU）治疗单侧放射性复发前列腺癌患者的肿瘤学和功能结局。
纳入原发性放射治疗后发生生化复发（BCR）且基于磁共振成像（mpMRI）与MRI靶向活检完全匹配存在单侧器官局限性复发证据的患者。排除有远处转移的患者。对患者进行系列血清前列腺特异性抗原（PSA）测定随访。采用Phoenix标准定义BCR。根据Clavien评分对并发症进行分级。使用国际勃起功能指数-5（IIEF-5）问卷评估勃起功能障碍。采用医生报告的发生率报告尿失禁情况。
前瞻性纳入了连续10例患者（中位年龄：71岁，四分位间距：69 - 76岁）。治疗前PSA中位数和治疗后PSA最低点分别为3.1ng/mL（四分位间距：1.54 - 8.59）和1.52ng/mL（四分位间距：0.76 - 2.2）。中位随访41.5（四分位间距：18 - 58）个月时，50%的患者出现BCR。24个月和36个月时无BCR生存率分别为75%（95%置信区间：31 - 93）和60%（95%置信区间：20 - 85）。2例患者发生II级尿失禁，其余患者无需使用尿垫。1例患者出现新发勃起功能障碍，需要使用5型磷酸二酯酶抑制剂（PDE5I）。勃起功能评分从平均10.1降至8.7。
半消融HIFU是单侧放射性复发前列腺癌患者全腺治疗的一种替代方法，其泌尿和直肠发病率有限，并能保留功能结局。
3级。
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