High-intensity focused ultrasound comparable to open surgery.


CLEVELAND—Clinical outcomes using high-intensity focused ultrasound (HIFU) for localized prostate cancer compare favorably to results with radical prostatectomy, while preserving quality of life, Japanese researchers reported.

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Although the study was not a randomized comparison of HIFU and radical prostatectomy, “HIFU therapy is an easy, safe, repeatable, and minimally invasive treatment,” said Kosuke Asano, MD. “Its clinical outcomes match those of radical prostatectomy in other series of patients.”


Dr. Asano and his colleagues at TakanobashiCentralHospital in Hiroshima treated 78 patients with biopsy-proven localized prostate cancer using HIFU, 56 of whom were followed for at least six months. Pre-treatment and six-month follow-up values were obtained for serum PSA, and the results of sextant biopsy and MRI were compared at baseline and again six months after the procedure in the 56 patients.


Quality-of-life (QOL) measures were assessed pretreatment and six months post-treatment using the International Prostate Symptom Score (IPSS) and the Functional Assessment of Cancer Therapy-General Prostate (FACT-G, P).


Patients’ initial median PSA level was 10.5 ng/mL. Thirty-five patients had stage T1c prostate cancer, 11 had stage T2a, 6 had stage T1b, and 4 had stage T2b. The Gleason score ranged from 5-9, with 7 being the most commonscore (28 men). Twenty-one of the patients had hormonal therapy previously, eight underwent transurethral resection of the prostate, and five had a previous HIFU.


There were no major complications associated with treatment and no intraoperative complications. Post-operative complications at six months were dysuria in four patients (7.1%) and urethral stenosis in two (3.6%).


At six months, prostate biopsies were negative in 54 of the 56 patients (96.3%). Fifty-three patients had a follow-up MRI, which revealed no remarkable change in any patient. Thirty-three patients had a change in PSA level of less than 1.0 ng/mL, 15 had a change of 1.0-3.9 ng/mL, and eight had a change of 4.0 ng/mL or greater. The complete response rate was 83.9% (47 of 56) using Gelet’s criteria.


There were also no significant changes from pretreatment to six months post-treatment in the IPSS, and mean scores on the FACT-Prostate scale did not change significantly.