High Intensity Focused Ultrasound - HIFU blijkt de veiligste en meest effectieve manier te zijn om prostaatkanker in het beginstadium na operatie te behandelen. Uitzaaingenvrije overleving op 8 jaar bleek 97% te zijn. Artikel geplaatst 27 juli 2010

27 juli 2010: Bron: Eur Urol 2010.

HIFU - High-Intensity Focused Ultrasound blijkt een veilige en effectieve manier om mannen met prostaatkanker in het beginstadium met nog geen aantoonbare uitzaaiingen te behandelen. Na 8 jaar bleek in de HIFU groep 99% nog in leven en 97% nog steeds geen uitzaaiingen te hebben tegenover 89% bij uitwendige bestraling. Dit blijkt uit een vergelijkende gerandomiseerde studie tussen uitwendige bestraling en HIFU na operatie.

"De algemene en kanker-specifieke overleving (CSSR) op 8 jaar waren 89% en 99%, respectievelijk." De 8-jarige metastase-vrije overleving bedroeg 97%.

Bij patiënten met een lage-, tussentijdse-en een hoog risico voor de ziekte, was na 7 jaar de biochemische-vrije overleving 75%, 63% en 62%, respectievelijk.
"HIFU kan herhaald worden indien nodig enkele maanden of enkele jaren na de eerste sessie en kan ook worden gevolgd door een palliatieve radiotherapie," zeggen de onderzoekers. "Dit verklaart waarschijnlijk de uitstekende mediane CSSR resultaten in deze multicentrische studie, ondanks de aanwezigheid van tussentijdse-en hoog-risico patiënten."

Multicentric Oncologic Outcomes of High-Intensity Focused Ultrasound for Localized Prostate Cancer in 803 Patients

Sebastien Crouzet, Xavier Rebillard, Daniel Chevallier, Pascal Rischmann, Gilles Pasticier, Gregory Garcia, Olivier Rouviere, Jean-Yves Chapelon, Albert Gelet.

Accepted 22 June 2010, Published online 2 July 2010

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Abstract

Background

High-intensity focused ultrasound (HIFU) is an emerging treatment for select patients with localized prostate cancer (PCa).

Objectives

To report the oncologic outcome of HIFU as a primary care option for localized prostate cancer from a multicenter database.

Design, setting, and participants

Patients with localized PCa treated with curative intent and presenting at least a 2-yr follow-up from February 1993 were considered in this study. Previously irradiated patients were excluded from this analysis. In case of any residual or recurrent PCa, patients were systematically offered a second session. Kaplan-Meier analysis was performed to determine disease-free survival rates (DFSR).

Measurements

Prostate-specific antigen (PSA), clinical stage, and pathologic results were measured pre- and post-HIFU.

Results and limitations

A total of 803 patients from six urologic departments met the inclusion criteria. Stratification according to d’Amico's risk group was low, intermediate, and high in 40.2%, 46.3%, and 13.5% of patients, respectively. Mean follow-up was 42 ± 33 mo. Mean PSA nadir was 1.0 ± 2.8 ng/ml with 54.3% reaching a nadir of ≤0.3 ng/ml. Control biopsies were negative in 85% of cases. The overall and cancer-specific survival rates at 8 yr were 89% and 99%, respectively. The metastasis-free survival rate at 8 yr was 97%. Initial PSA value and Gleason score value significantly influence the DFSR. The 5- and 7-yr biochemical-free survival rates (Phoenix criteria) were 83–75%, 72–63%, and 68–62% (p = 0.03) and the additional treatment-free survival rates were 84–79%, 68–61%, and 52–54% (p < 0.001) for low-, intermediate-, and high-risk patients, respectively. PSA nadir was a major predictive factor for HIFU success: negative biopsies, stable PSA, and no additional therapy.

Conclusions

Local control and DFSR achieved with HIFU were similar to those expected with conformal external-beam radiation therapy (EBRT). The excellent cancer-specific survival rate is also explained by the possibility to repeat HIFU and use salvage EBRT.

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