Neymark A I, Tachalov M A, Neymark B A, Levin V P
Department of Urology and Andrology with a course of Specialized Surgery of FGBOU VO Altai State Medical University of the Ministry of Health of Russia, Barnaul, Russia.
Department of Urology of Private Clinical Hospital Russian Railways Medicine, Barnaul, Russia.
Urologiia. 2020 Jun(3):69-76.
to study the clinical, morphological and microcirculatory criteria for treatment efficiency and prognosis of local recurrence after HIFU.
On the basis of the urological department of Clinical Hospital "Russian Railways - Medicine" in Barnaul (the clinical base of the Department of Urology and Andrology with a course of Specialized Surgery of FGBOU VO "Altai State Medical University") for the period 2011-2018, a comprehensive examination and treatment of 240 patients with prostate cancer (PCa) by means of HIFU using "Ablatherm" was performed following transurethral resection of the prostate (TURP). The indication for HIFU was morphologically-proven PCa (stage T2a-cN0M0) in patients with contraindications due to comorbidities or those who refused from radical prostatectomy.
A decrease in PSA to 0.5 ng/ml or less was observed in 74% of patients. A stable PSA level for 3 years was observed in 76% of patients. PSA levels differed depending on the PCa risk group. In the low-risk PCa, negative biopsy was seen in 89.6% of cases, in comparison with 72.2% and 69.4% in intermediate and high-risk PCa, respectively. There was a significant decrease in the volume of the prostate in all patients with low-risk PCa. The largest decrease in prostate volume was observed 12 months after HIFU. Regarding recurrence-free survival after HIFU therapy, during follow-up of 3 years or more, 77% of patients didnt have any signs of recurrence. A 3-year overall survival after HIFU was 83%. In addition, an increase in postoperative PSA levels, change in parameters of Doppler study and laser Doppler flowmetry at the area of the prostate during the period of 6-36 months after HIFU was associated with a significant increase in the risk of recurrence of PCa at biopsy.
HIFU therapy is an effective treatment method for inducing prostate necrosis with minimal collateral damage to the surrounding tissue. The best results were achieved in patients with low-risk PCa. There were minimal adverse events after HIFU. In addition, in case of relapse after HIFU therapy, there is an opportunity for an early assessment of the efficiency and prognosis.
研究高强度聚焦超声（HIFU）治疗后局部复发的治疗效果及预后的临床、形态学和微循环标准。
以巴尔瑙尔市“俄罗斯铁路 - 医学”临床医院泌尿外科为基础（阿尔泰国立医科大学泌尿外科与男科学系临床基地，开展专科外科课程），在2011 - 2018年期间，对240例前列腺癌（PCa）患者在经尿道前列腺切除术（TURP）后采用“Ablatherm”进行HIFU综合检查和治疗。HIFU的适应症为因合并症有禁忌或拒绝根治性前列腺切除术的形态学确诊的PCa（T2a - cN0M0期）患者。
74%的患者前列腺特异性抗原（PSA）降至0.5 ng/ml或更低。76%的患者PSA水平稳定3年。PSA水平因PCa风险组而异。在低风险PCa患者中，89.6%的病例活检呈阴性，而中风险和高风险PCa患者的这一比例分别为72.2%和69.4%。所有低风险PCa患者的前列腺体积均显著减小。HIFU治疗后12个月观察到前列腺体积减小最大。关于HIFU治疗后的无复发生存率，在3年或更长时间的随访中，77%的患者没有任何复发迹象。HIFU治疗后3年总生存率为83%。此外，HIFU治疗后6 - 36个月期间，术后PSA水平升高、前列腺区域多普勒研究和激光多普勒血流仪参数变化与活检时PCa复发风险显著增加相关。
HIFU治疗是一种诱导前列腺坏死且对周围组织附带损伤最小的有效治疗方法。低风险PCa患者取得了最佳效果。HIFU治疗后不良事件极少。此外，HIFU治疗后复发时，有机会对治疗效果和预后进行早期评估。
