局部高能聚焦式超音波在中低風險攝護腺癌的治療效果與併發症

徐明蔚、黃志平、王又德、連啟舜、謝博帆

中國醫藥大學附設醫院 泌尿部

Focal high-intensity focused ultrasound (HIFU) therapy in low to intermediate-risk prostate cancer: preliminary outcomes in a single center

Ming-Wei Hsu, Chi-Ping Huang, Yu-De Wang, Chi-Shun Lien, Po-Fan Hsieh

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Purpose

Focal therapy has the advantage of both cancer control and less sequela in localized prostate cancer, compared with whole-gland approaches like prostatectomy or radiotherapy. Magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion technique can help us precisely localize the tumor lesions. Focal high-intensity focused ultrasound (HIFU) therapy enables targeted ablation of cancerous lesions and avoids excessive damage to normal prostate tissue. We present the preliminary oncological and functional outcomes of focal HIFU therapy.

Materials and Methods

From 2018 to 2022, 9 patients diagnosed with prostate cancer underwent primary focal HIFU therapy using the Ablatherm or Sonablate device in a single institution. All patients had prostate mpMRI and targeted biopsy before HIFU therapy. Biochemical failure rate (Phoenix criteria), functional outcomes with potency sufficient for intercourse and continence without any pad use, and complications using the Common Terminology Criteria for Adverse Events (CTCAE) were also reported.

Results

A total of 9 patients were enrolled. The median age was 71 years old. The median iPSA was 5.25ng/mL. Gleason scores are 3+3, 3+4 and 4+3, in 4, 1, and 4 men, respectively. Clinical T stage ranged from cT1c to cT2b. The ablation type included wide local ablation, hemiablation, dogleg ablation in 2, 3, and 4 men, respectively. At a median follow-up of 7 months (range 1-33 months), there was no biochemical failure. No patient requires whole-gland salvage treatment, second focal therapy or systemic treatment. One had incontinence with daily one pad use. One had erectile dysfunction. One man had rectourethral fistula and underwent T-colostomy. One patient had UTI and was treated with antibiotics at clinics. All patients survived till now.

Conclusion