Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Results of high intensity focused ultrasound treatment of prostate cancer: early Canadian experience at a single center

Dean S. Elterman^1,2, Jack Barkin^1,3, Sidney B. Radomski¹, Neil E. Fleshner¹, Brian Liu¹, Kira Bensimon¹, Samantha Arora¹, Michael Robinette¹, Antonio Finelli¹

1 Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
2 Department of Urology, Weill Cornell Medical College, New York, New York, USA
3 Division of Urology, Humber River Regional Hospital, Toronto, Ontario, Canada
Address correspondence to Dr. Jack Barkin, Humber River Regional Hospital, 960 Lawrence Avenue West, Suite 404, Toronto, Ontario M6A 3B5 Canada

Canadian Journal of Urology 2011, 18(6), 6037-6042.

Abstract

Introduction: High-intensity focused ultrasound (HIFU) is a non-invasive technique that uses focused ultrasound waves to ablate tissue. This retrospective study evaluates the early HIFU experience at a single Canadian center.
Materials and methods: Ninety-five patients were treated between March 2006 and December 2007 using the Sonablate 500 device (Focus Surgery, Indianapolis, IN, USA). Follow-up was conducted at 3-month intervals and included serial prostate-specific antigen (PSA) measurements, assessment of erectile function using the International Index of Erectile Function (IIEF), and evaluation of continence rates using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. Early and late complications were also recorded.
Results: A total of 95 patients were treated by five urologists. The mean patient age was 64 years (range: 46–91). Most patients had Gleason 6 (n = 53) or Gleason 7 (n = 35) disease; a smaller number had Gleason 8 (n = 5) and Gleason 9 (n = 2) prostate cancer. Pre-treatment prostate volume averaged 30.5 cc (range: 14.4–73 cc). Ten men received cytoreductive androgen deprivation therapy prior to HIFU. Post-HIFU follow-up with a minimum of 6 months (mean 10.62 months) showed that 2% (1/59) of men developed de novo moderate to severe erectile dysfunction (IIEF ≤ 11). Among those with ≥ 6 months follow-up (mean 8.85 months), 17% (7/41) experienced significant incontinence based on EPIC scores. Early complications included catheter-related issues (n = 10), urinary retention (n = 16), and urosepsis (n = 1). Late complications included need for cystoscopy (n = 25), transurethral resection of the prostate (TURP) (n = 6), visual internal urethrotomy/dilatation for stricture or bladder neck contracture (n = 13), and self-catheterization (n = 1). One patient with prior radiotherapy developed a prostatorectal fistula. Salvage HIFU following radiation failure was performed in seven men. Recurrence after HIFU was diagnosed in seven men, and salvage treatments included radical prostatectomy (n = 3), radiation therapy (n = 2), repeat HIFU (n = 1), and hormone therapy (n = 1).
Conclusions: In our early experience, HIFU treatment for prostate cancer was associated with a moderate rate of complications and treatment failure. Further studies are needed to evaluate long-term outcomes with HIFU.

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