Survival and quality of life outcomes of high intensity focused ultrasound (HIFU) treatment of localised prostate cancer

作者：Peter L. Royce; James J.Y. Ooi; Selva Sothilingam; Henry H.I. Yao

来源：Prostate International, 2020.

DOI：10.1016/j.prnil.2019.12.002

• Prostatic Neoplasms
• High-Intensity Focused Ultrasound Ablation
• Treatment Outcome
• Mortality
• Disease-Free Survival
• Quality of Life
• Urinary Incontinence
• Erectile Dysfunction

Background
To evaluate the survival and quality of life (QoL) outcomes of high intensity focused ultrasound (HIFU) whole-gland ablation for localised prostate cancer.
Methods
Over 8 years, men with localised prostate cancer treated with whole-gland HIFU were prospectively followed. Transrectal prostate ablation was performed under general anaesthesia with Sonablate-500® (Sonacare Medical©). The primary outcome was failure-free survival (FFS) defined as no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included both survival outcomes and QoL measures.
Results
Of 70 men, 29.7% had International Society of Urological Pathology (ISUP) 1, 43.8% ISUP 2, 10.9% ISUP 3 and 15.6% ISUP 4 disease. At median follow-up 83.4 months, overall mortality was 8.6% and prostate cancer-specific mortality 0%. Failure-free survival was 78.2% at 5 years and 71.2% at 7 years. 7.1% of men developed metastases, with median metastasis-free survival of 75.4 months. There was negligible post-HIFU urinary incontinence or LUTS with median MUDI score of 32 at 6 months, 33 at 12 months and median IPSS of 4 at 6 months, 3 at 12 months. Median RTOG rectal toxicity score was 0 throughout. In men who had mild or no erectile dysfunction at baseline (IIEF-5 ≥17), mean IIEF-5 score declined 37% from 23.5 at baseline to 14.7 at 12 months.
Conclusion
At median follow-up of 7 years, whole-gland HIFU appears to have comparable survival outcomes to other cohort studies involving radical prostatectomy and radiotherapy patient. It has low impact on QoL, preserved urinary continence and erectile function approximate to nerve-sparing prostatectomy. Whole-gland HIFU presents a potential alternative minimally invasive and safe option for the treatment of localised prostate cancer.