比較海扶刀單獨治療與海扶刀合併經尿道前列腺切除術在低及中風險攝護腺癌的腫瘤療效與 PSA 動態變化：風險分層分析

鄭名傑、林祖丞、林寬宇、虞凱傑

林口長庚紀念醫院 外科部 泌尿科

Oncological Efficacy and PSA Kinetics of HIFU Monotherapy Versus Combined HIFU and TURP in Low- and Intermediate-Risk Prostate Cancer: A Risk-Stratified Analysis

Ming-Chieh Cheng, Tsu-Chen Lin, Kuan-Yu Lin, Kai-Jie Yu

Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan

Purpose: The objective of this study was to perform a risk-stratified analysis comparing the oncological efficacy and prostate-specific antigen (PSA) kinetics of High-Intensity Focused Ultrasound (HIFU) monotherapy versus combined HIFU and Transurethral Resection of the Prostate (HIFU+TURP). The analysis specifically focused on biochemical recurrence (BCR) and deep PSA response rates in patients with D'Amico low- and intermediate-risk localized prostate cancer within one year.

Materials and Methods: This retrospective study included 63 patients (30 HIFU, 33 HIFU+TURP) treated at a tertiary medical center in Taiwan between February 2021 and February 2024. Patients were stratified by D'Amico risk classification. Primary endpoints included the  BCR rate (Phoenix criteria: nadir + 2 ng/mL) and deep PSA response rates (PSA90 and PSA80, defined as ≥ 90% and ≥ 80% decline from baseline, respectively) within one year. Secondary endpoints assessed the time to achieve deep PSA response using Kaplan–Meier analysis and log-rank tests.

Results: Baseline characteristics were comparable between groups. While no significant difference was observed in the overall one-year BCR rate (HIFU: 6.7% vs. HIFU+TURP: 0.0%; p=0.132), the combined therapy group showed superior deep PSA response metrics. In the intermediate-risk cohort, the HIFU+TURP group achieved a significantly higher "Ever Reach PSA90" rate (82.6% vs. 52.4%; p=0.032) and a significantly higher one-year PSA80 rate (91.3% vs. 57.1%; p=0.009). Furthermore, the addition of TURP significantly accelerated the time to achieve PSA80 in intermediate-risk patients (Hazard Ratio: 1.979; p=0.037) within one year.

Conclusion: Although adding TURP to HIFU did not significantly impact one-year BCR, it resulted in higher proportions of patients achieving deep PSA responses and a better distribution inKaplan–Meier analysis and log-rank tests . These oncological benefits were most pronounced in the intermediate-risk population, suggesting that the HIFU+TURP combined approach offers more effective local disease control for this specific patient cohort.