吳彥廷、柳易揚、江博暉

高雄長庚紀念醫院 泌尿科

Yen-Ting Wu, Yi-Yang Liu, Po-Hui Chiang

Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

 

Purpose: In this article we report medium-term outcomes in men receiving primary whole-gland HIFU and salvage treatment modalities after failure.

 

Materials and Methods: We reviewed 122 patients receiving HIFU for localized prostate cancer from December 2009 to February 2015. Oncological outcome and complications after primary HIFU, as well as outcome after salvage treatment are analyzed.

 

Results: Median follow-up duration was 53.6 months. D’Amico risk classification low-, intermediate-, and high-risk disease was 14 (11.5%), 51 (41.8%), and 57 (46.7%) patients, respectively. Overall 5-year biochemical recurrence-free and salvage treatment-free survival rate after primary HIFU was 66.4% and 54.1%. 5-year biochemical recurrence-free survival rate was 85.7%, 82.4%, and 47.4% for D’Amico low-, intermediate-, and high-risk groups, respectively. Moreover, 5-year salvage treatment-free survival rate was 71.4%, 70.6%, and 35.1% for D’Amico low-, intermediate-, and high-risk groups, respectively. Metastasis was noted in 6 patients. Fifty-eight patients with biochemical recurrence underwent salvage treatment and 31 patients (53.4%) achieved good oncologic control after repeated HIFU or salvage radiotherapy. Only 3 patients (2.5%) had urinary incontinence with pad needed for more than three months. Of 32 patients with good baseline erectile function, 11 patients (34.4%) maintained good function.

Conclusion: Whole-gland HIFU is an effective treatment option for localized prostate cancer, especially in D’Amico low- and intermediate-risk diseases. Even some patients experienced PSA biochemical recurrence, successful rate of salvage treatment is still acceptable. In addition, complication rate after primary HIFU is lower than other alternative treatment modality. Long term follow-up is still needed for 10 to 15-year-oncological control.