Transrectal high-intensity focused ultrasound:: Minimally invasive therapy of localized prostate cancer

Background and Purpose: Criteria for determining the durability of the response to transrectal high-intensity focused ultrasound (HIFU) ablation of prostate cancer have been established by calculating progression-free probability. Patients and Methods: A series of 82 patients (mean age 71 +/- 5.7 years) with biopsy-proven localized (stage T-1-T-2) cancer who were not suitable candidates for radical surgery underwent transfectal HIFU ablation with the Ablatherm(TM) machine. The mean follow-up was 17.6 months (range 3-68 months). The mean serum prostate specific antigen (PSA) value and mean prostate volume were 8.11 +/- 4.64 ng/mL and 34.9 +/- 17.4 cm(3), respectively. Progression was rigidly defined as any positive biopsy result, regardless of PSA concentration, or three successive PSA increases for patients with a negative biopsy (PSA velocity greater than or equal to 0.75), Times to specific events (positive biopsy and PSA elevation) were analyzed with the Kaplan-Meier survival method. Results: Overall, 62% of the patients exhibited no evidence of disease progression 60 months after transrectal HIFU ablation, In particular, the disease-free rate was 68% for the moderate-risk group of 50 patients (PSA <15.0 ng/mL, Gleason sum <8, prostate volume <40 cm(3), and number of positive biopsies <5), For the low-risk group of 32 patients (PSA <10 ng/mL and Gleason sum <7), the disease-free survival rate was 83%, Conclusion: Transrectal HIFU prostate ablation is an effective therapeutic alternative for patients with localized prostatic adenocarcinoma.