7 juli 2009: Bron: BBV news van 1 juli.

HIFU - High Intensity Focused Ultrasound succesvol toegepast bij mannen met beginnende prostaatkanker. Van de 172 mannen behandelde mannen bleken er 159 ( 92% )  na een jaar geen recidief verschijnselen te hebben na slechts 1 HIFU behandeling. Dit succes percentage komt weliswaar overeen met behandelingen met operatie en bestraling maar met veel minder bijwerkingen en significant minder incontinentie en minder verlies aan potentie dan bij operatie en bestraling.  Bovendien kan deze behandeling poliklinisch worden uitgevoerd. De onderzoekers pleiten dan ook voor meer aandacht voor HIFU bij beginnende prostaatkanker. Aldus abstract van studie en ook BBC news gaf hier aandacht aan . Achtereenvolgens artikel van BBC news en daaronder het abstract van de studie zoals gepubliceerd in British Journal of Cancer.  

Bron: BBC news

An experimental therapy using sound waves may offer people with early stage prostate cancer an alternative treatment option, doctors believe.

The technique, called High Intensity Focused Ultrasound (HIFU), uses sound waves to heat and kill cancerous cells.
The researchers from University College and Princess Grace hospitals in London used it on 172 men with high rates of success and low levels of side effects.
But experts said long-term follow-up was needed to confirm its potential.
The men taking part in the trial were discharged on average five hours after receiving the HIFU treatment, the British Journal of Cancer reported.

The day following the treatment I was walking the dog, washing the car and going Christmas carolling
Guy MacPherson, cancer patient

Typically men with the aggressive form prostate cancer, which kills 10,000 people a year in the UK, are treated with either surgery or radiotherapy.
There is also a benign version of the disease, which is rarely life-threatening and sometimes so slow-growing it never causes any problems.
Surgery usually requires a two to three-day in-patient stay and radiotherapy requires daily treatment as an outpatient for up to one month.
Of the initial group, 159 men were followed up a year later and 92% did not have any recurrence of prostate cancer.
Both surgery and radiotherapy have similar success rates.
But the sound waves treatment showed lower levels of side effects than would be expected for the other two.
Just one man had incontinence, none had any bowel problems, while a third of the group had impotence - low in terms of prostate treatment.
'Needs evaluation'
Guy MacPherson, 73, from Oxfordshire, who took part in the trial, was full of praise.
"I was very happy about the treatment. I had no side effects.
"The day following the treatment I was walking the dog, washing the car and going Christmas carolling."
Dr Hashim Ahmed, who led the trial, said the results were very encouraging.
"This study suggests it's possible that HIFU may one day play a role in treating men with early prostate cancer with fewer side effects."
HIFU can target cancerous tissue down to a millimetre accuracy.
It literally boils the cells until they are destroyed.
Since this first group underwent the treatment another 800 men around the UK have also entered trials, although results are not available yet.
It has also started to be tested on other forms of cancer, such as liver and kidney.
The technique is already used in other parts of Europe and Japan.
But experts still want to see long-term results before they give it their backing for NHS use.
Professor Peter Johnson, of Cancer Research UK, said HIFU needed "careful evaluation".
And John Neate, chief executive of the Prostate Cancer Charity, added long-term data was required.
But he said: "HIFU potentially offers a 'third way' approach to the treatment of localised prostate cancer."

Bron: 1: Br J Cancer. 2009 Jul 7;101(1):19-26. Epub 2009 Jun 9.Click here to read Links

High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series.
Ahmed HU, Zacharakis E, Dudderidge T, Armitage JN, Scott R, Calleary J, Illing R, Kirkham A, Freeman A, Ogden C, Allen C, Emberton M.
Division of Surgery and Interventional Sciences, University College London, London, UK. hashim.ahmed@ucl.ac.uk
BACKGROUND: The use of minimally invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy.
METHODS: An analysis of men with organ-confined prostate cancer treated with transrectal whole-gland HIFU (Sonablate 500) between 1 February 2005 and 15 May 2007 was carried out in two centres. Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated.
RESULTS: A total of 172 men were treated under general anaesthetic as day-case procedures with 78% discharged a mean 5 h after treatment. Mean follow-up was 346 days (range 135-759 days). Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P=0.005). Antibiotics were given to 23.8% of patients for presumed urinary tract infection and the rate of epididymitis was 7.6%. Potency was maintained in 70% by 12 months, whereas mild stress urinary incontinence (no pads) was reported in 7.0% (12 out of 172) with a further 0.6% (1 out of 172) requiring pads. There was no rectal toxicity and no recto-urethral fistulae. In all, 78.3% achieved a PSA nadir < or =0.5 microg ml(-1) at 12 months, with 57.8% achieving < or =0.2 microg ml(-1). Then, 8 out of 13 were retreated with HIFU, one had salvage external beam radiotherapy and four chose active surveillance for small-volume low-risk disease. Overall, there was no evidence of disease (PSA <0.5 microg ml(-1) or negative biopsy if nadir not achieved) after one HIFU session in 92.4% (159 out of 172) of patients.
CONCLUSION: HIFU is a minimally invasive, day-case ablative technique that can achieve good biochemical outcomes in the short term with minimal urinary incontinence and acceptable levels of erectile dysfunction. Long-term outcome needs further evaluation and the inception of an international registry for cases treated using HIFU will significantly aid this health technology assessment.
PMID: 19513068 [PubMed - in process]


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