Six years' experience with high-intensity focused ultrasonography for prostate cancer: oncological outcomes using the new 'Stuttgart' definition for biochemical failure.
BJU Int
; 107(12): 1899-905, 2011 Jun.
Article
em En
| MEDLINE
| ID: mdl-21083637
ABSTRACT
OBJECTIVE:
⢠To determine oncological outcomes after high-intensity focused ultrasonography (HIFU) treatment in patients with localized prostate cancer using a new, more accurate, definition ('Stuttgart' definition) of biochemical failure. PATIENTS ANDMETHODS:
⢠We performed a retrospective review of all patients in our centre who received first-line treatment with a second-generation Ablatherm™ device (EDAP-TMS, Lyon, France). ⢠Oncological failure was given either by biochemical failure (prostate-specific antigen, PSA, nadir plus 1.2 g/mL) (Stuttgart definition) or the start of salvage therapy because of a persistently positive biopsy after the HIFU procedure. ⢠The 5-year biochemical-free survival rate and 5-year disease-free survival rate were calculated.RESULTS:
⢠In total, 53 patients were included (mean age, 72.5 ± 4.5 years, range 60-79 years; 28 low risk and 25 intermediate risk). None had undergone previous hormonal therapy. Mean ±sd follow-up was 45.4 ± 15.5 months (range 16-71 years). Mean (range) pre-treatment PSA was 8.5 ± 4 (0.29-18) ng/mL. The median (range) PSA nadir value was 1 (0.01-14) ng/mL and occurred after a mean (range) of 5.09 (3-24) months. ⢠Overall, 36 patients (67.9%) experienced oncological failure. ⢠These included 33 cases (62.2%) of biochemical failure. A PSA nadir of ≤0.2, 0.21-1.0 and >1 ng/mL was reached in 20.8%, 30.2% and 49% of patients, respectively, and was associated with biochemical failure in 9.1%, 30.3% and 60.6%, respectively. ⢠The 5-year biochemical-free survival rate and disease-free survival rate were 21.7% and 13.5%, respectively. In multivariate analysis, a PSA nadir of >1 ng/mL was significantly associated with a risk of biochemical and oncological failure (P= 0.002 and P < 0.001). ⢠Oncological failure was not associated with any risk group. ⢠No patient died from prostate cancer.CONCLUSIONS:
⢠In our experience, Ablatherm™ treatment for clinically localized prostate cancer was associated with a high rate of biochemical failure as determined by the 'Stuttgart' definition, and did not achieve effective cancer control. ⢠The PSA nadir value after HIFU treatment was a significant predictor of treatment failure.
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Próstata
/
Terapia de Salvação
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Ultrassom Focalizado Transretal de Alta Intensidade
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Recidiva Local de Neoplasia
Idioma:
En
Ano de publicação:
2011
Tipo de documento:
Article