Focal High-intensity Focused Ultrasound Targeted Hemiablation for Unilateral Prostate Cancer: A Prospective Evaluation of Oncologic and Functional Outcomes
Menée sur 67 patients traités entre 2009 et 2013 pour un cancer localisé de la prostate (âge moyen : 70,2 ans ; durée médiane de suivi : 12 mois), cette étude évalue l'efficacité, du point de vue du contrôle de la maladie, et les complications génito-urinaires associées à l'ablation du lobe prostatique impliqué par ultrasons focalisés de haute intensité
Background : In selected patients with unilateral, organ-confined prostate cancer (PCa), hemiablation of the affected lobe might be feasible to achieve acceptable cancer control with fewer complications. Objectives : To assess the oncologic and functional outcomes of focal high-intensity focused ultrasound (HIFU) hemiablation in unilateral organ-confined PCa. Design, setting and patients : Single-center prospective evaluation of HIFU hemiablation for unilateral organ-confined PCa was performed from July 2009 through December 2013. Intervention : Cancer localization was done with transrectal ultrasound–guided biopsy and multiparametric magnetic resonance imaging followed by HIFU hemiablation. Outcome measurement and statistical analysis : Oncologic outcomes were analyzed with control biopsies and prostate-specific antigen (PSA) measurement. Functional outcomes were assessed with validated questionnaires for genitourinary symptoms. Results and limitations : Of 71 HIFU hemiablation patients, 67 completed the study protocol. The mean age was 70.2 yr (standard deviation: 6.8 yr), and median PSA was 6.1 ng/ml (interquartile range [IQR]: 1.6–15.5 ng/ml). Median maximum cancer-core length was 3 mm (IQR: 2–10 mm), and total cancer length was 6.5 mm (IQR: 2–24 mm). Gleason score was 6 (3 + 3) in 58 patients (86.6%) and 7 (3 + 4) in 9 patients (13.4%). Median follow-up was 12 mo (IQR: 6–50 mo), and at 12 mo, 56 of 67 patients had a negative control biopsy in the treated lobe. At 3 mo, all patients were continent, and potency was maintained in 11 of 21 preoperatively potent patients (confidence interval, 0.18–0.69). Complications included 8% Clavien–Dindo grade 2 and 2.8% grade 3 events. Conclusions : Focal HIFU hemiablation appears to achieve acceptable oncologic outcomes with low morbidity and minimal functional changes. Longer follow-up will establish future considerations. Patient summary : This study showed that high-intensity focused ultrasound hemiablation in selected patients with unilateral organ-confined prostate cancer can be used for satisfactory cancer control with minimal effect on genitourinary functions.