以海福刀治療局限性前列腺癌 : 國泰綜合醫院的經驗
蔡樹衛 林志明 謝德生 羅華安 陳國強
國泰綜合醫院 外科部 泌尿科
High-intensity focused ultrasound (HIFU) therapy for localized prostate cancer : Cathy General Hospital experience
Shu-Wei Tsai, Chih-Ming Lin, Teh-Sheng Hsieh, Kuo-Chiang Chen
Divisions of Urology, Department of Surgery
Cathay General Hospital, Taipei, Taiwan, R.O.C
Purpose:
High intensity focused ultrasound (HIFU) is a promising modality to treat tumors in a complete, non invasive fashion where online image guidance and therapy control can be achieved by magnetic resonance imaging or diagnostic ultrasound. To report our preliminary results of high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer.
Materials and Methods:
From Jan, 2012 to Dec, 2015, 33 patients with localized prostate cancer (cT1c-T2cN0M0) were treatment with Ablatherm™ HIFU device. We investigated the efficacy using post-treatment prostate specific antigen (PSA) levels and complications. PSA level was monitored after HIFU therapy, and then every three months thereafter. Biochemical failure was defined by a PSA rise of 2 ng/mL or more above the PSA nadir.
Results:
Mean age of all patients was 69.12 (from 49 to 80) years, and the average pretreatment PSA level was 15.19 (from 4.44 to 62.91) ng/mL, Gleason score from 6 (3+3) to 9 (4+5). The mean prostate volume was 38.72 (from 21 to 77) ml. The mean follow-up was 30.2 (form 6 to 52) months. Ten patients were classified to low risk , ten patients were classified to intermittent risk and thirteen patients were classified to high risk by NCCN guideline of recurrent risk . All patients PSA level was dropped significantly after HIFU therapy, and even undetectable PSA(0.04ng/ml) level was found among four patient (12.12%). Post-treatment mean PSA nadir was 0.609 (3.21 to 0.04)ng/ml and mean follow-up was 3.1(from 1 to 8)months. Survival rate was 100 % .PSA biochemical failure rate was 72.7% (24/33). Post-treatment complications including urge incontinence (3/33), total urinary incontinence (0/33), bladder neck contracture (5/33), urethral stricture (1/33).
Conclusion:
High-intensity focused ultrasound therapy appears to be an effective and minimally invasive therapy for localized prostate cancer with acceptable complications. HIFU seems to result in short- to medium-term cancer control, with a low rate of complications comparable with those of established therapies. However, longer-term follow-up studies are needed to evaluate cancer-specific and overall survival. HIFU seems particularly promising for focal ablation, given the precision of targeting, its low morbidity, and the ability to use magnetic resonance thermography to monitor the temperature in the rectum, urinary sphincter, and neurovascular bundles during treatment.
In our report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.