高能聚焦式超音波合併與不合併經尿道前列腺刮除術在局部性攝護腺癌的預後分析

徐明蔚、黃志平、陳汶吉、連啟舜、陳冠亨、王又德、蔡禮賢、謝博帆

中國醫藥大學附設醫院 泌尿部

Outcomes between High-intensity focused ultrasound ablation with and without transurethral resection of the prostate in the patients with localized prostate cancer

Ming-Wei Hsu, Chi-Ping Huang, Wen-Chi Chen, Chi-Shun Lien, Guang-Heng Chen, Yu-De Wang, Li-Hsien Tsai, Po-Fan Hsieh

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

Purpose

High-intensity focused ultrasound ablation (HIFU) is an emerging alternative therapy for prostate cancer (PCa) that shows great promise as a technique that falls somewhere between active surveillance and radical prostatectomy. HIFU combined with transurethral resection of the prostate (TURP) is said to increased ablation efficacy and reduced complications. However, current guidelines do not offer a definitive recommendation on whether to combine TURP with HIFU therapy for patients with PCa. The objective of this study was to compare outcomes and complications between HIFU plus TURP and HIFU alone in patients with localized prostate cancer in a single center.

Materials and Methods:

Between April 2018 and November 2022, we enrolled 32 male patients with localized prostate cancer who underwent HIFU therapy at CMUH. These patients were split into two groups: those who received HIFU alone (N=11) and those who underwent HIFU plus TURP (N=21). Our goal is to compare the biochemical recurrence-free survival rates, the incidence of urine incontinence, and the occurrence of complications such as infections, urine retention, and urethral stricture between the two groups.

Results

The mean age of the cohort was 69.7 ± 7.4 years with a median follow-up of 22 (range 3–60) months. Median iPSA level was 8.17 ng/mL. According to D'Amico classification, 8 patients were considered high risk; 19 were intermediate risk and 5 were low risk. Median foley catheter indwelling time were 2 weeks. Among them, 21patients underwent HIFU plus TURP and 11 underwent HIFU alone.

The median biochemical recurrence-free survival of the entire cohort was 15 months. The group with HIFU plus TURP had a similar median biochemical recurrence-free survival to the HIFU alone group (17 vs. 11.5 months, p = 0.86). The incidence of urine incontinence (23% vs. 18%, p = 1), urinary tract infection that needs admission (9% vs. 18%, p = 0.58) and acute urine retention that needs intervention (18% vs. 18%, p = 1) were also similar between the two groups. For urethral stricture requiring long-term sounding, HIFU plus TURP group seemed to have higher rate than HIFU alone group (18% vs. 0%) but no significant difference was achieved (p = 0.27).

Conclusion:

Our experience showed preliminary outcomes and complications between HIFU with TURP and HIFU alone and it seems there is no significant difference in oncological, functional outcomes and complications between both groups. HIFU plus TURP group seems to have higher urethral stricture rate; however, large scale study should be investigated.