侷限性攝護腺癌病人接受根除性經尿道前列腺切除術併海福刀治療失敗後運用第二次海福刀做為補救性治療
蔡佳宏1、江博暉1
高雄長庚紀念醫院 泌尿科1
Secondary HIFU as salvage treatment after failure
Of radical TURP plus HIFU for localized prostate cancer
Tsai-Chia Hung,, Po-Hui Chiang
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Purpose: We present our data by using secondary HIFU in the management of residual tumor after primary HIFU, with the aim of determining efficacy and safety of this modality.
Materials and Methods: A total of 148 patients underwent HIFU for primary treatment of localized prostate cancer from December 2009 to July 2015. 12 patients were offered HIFU as secondary salvage management. All of these had histologically proven residual/ recurrent prostate cancer after primary HIFU. 8 were given HIFU as the only management, 3 were given hormone therapy with HIFU, and 1 received HIFU, hormone therapy and radiotherapy.
Results: The mean pre-secondary HIFU PSA was 2.28 ng/ml (0.52-4.77). After salvage HIFU, 8 out of 12 patients (66.7%) achieved nadir PSA less than 50% of pre-treatment values. These showed biochemical disease free survival. Mean post-treatment nadir PSA value was 0.39 ng/ml (0.02-0.75). Time to achieve post-treatment PSA nadir was 1.13 months (1-2). The 8 patients had mean post-treatment PSA of 0.78 ng/ml (0.02-1.78) when followed up over a mean period of 11.25 months (1-20), demonstrating biochemical disease free survival.
The salvage procedure was well tolerated by the patients with minimal side effects. No major complications were found in our patients (rectal injury, fistula, incontinence of urine, epididmyo-orchitis). One patient developed urethral stricture and required optical internal urethrotomy.
Conclusions: Our early clinical results show the feasibility and good tolerance of salvage HIFU as a management option after primary treatment of prostate cancer with HIFU. Oncological outcomes are satisfactory. No major side effects were noted. Currently there are very few, if any, clinical trials globally, that have studied HIFU as a salvage treatment option after primary HIFU for localized prostate cancer. Larger prospective studies with longer follow-up are needed to confirm our initial results.