海福刀挽救性治療對於殘存前列腺癌之初步治療成果
Sharjil Wahid, Guan-Lin Huang, Po-Hui Chiang
高雄長庚紀念醫院 泌尿科
Salvage HIFU (high-intensity focused ultrasound)
in the management of prostate residual tumor after primary HIFU
Sharjil Wahid, Guan-Lin Huang, Po Hui Chiang
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Purpose:
Recent data on the Ablatherm® HIFU device shows a 5-year biochemical disease-free survival rate of 80-85%. 15-20% patients have residual tumor when treated by HIFU for localized prostate cancer. HIFU can also be used as salvage therapy after radical prostatectomy and external-beam radiotherapy. There has been little or no literature about this novel use of secondary HIFU. We present our data of 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 168 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.
3 patients (25%) had elevation of PSA, mean 5.6 ng/ml (3.17-7.52), after salvage HIFU. These were registered as failures. One patient was excluded from the study because of negative prostate biopsy, which meant that it could not be ascertained that the disease was localized or metastatic.
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). 1 patient developed urethral stricture and required optical internal urethrotomy/ TURP.
Conclusion:
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.