- Email: [email protected]
FACTORS PREDICTING THE FORMATION OF BLADDER OUTLET OBSTRUCTION AFTER HIGH-INTENSITY FOCUSSED ULTRASOUND (HIFU) TREATMENT OF LOCALISED PROSTATE CANCER
193 SALVAGE HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU) THERAPY FOR LOCALLY RECURRENT PROSTATE CANCER AFTER PRIMARY HIFU OR EXTERNAL BEAM RADIOTHERAPY (EBRT)
194 PROGNOSTIC FACTORS FOR SALVAGE HIFU SUCCESS AFTER EXTERNAL BEAM RADIATION FAILURE (EBRT) FAILURE
Seo S.I.1, Jeon S.S.1, Jo M.K.2, Lee H.M.1, Choi H.Y.1
Murat F.J.1, Poissonnier L.1, Pricaz E.1, Rouviere O.2, Mege F., Chapelon J.Y.4, Colombel M.1, Gelet A.1
1
Samsung Medical Centre, Sungkyunkwan University School of Medicine, Dept. of Urology, Seoul, South Korea, 2Korea Cancer Centre Hospital, Dept. of Urology, Seoul, South Korea
1
Introduction & Objectives: 7R HYDOXDWH WKH HᚑFDF\ DQG VDIHW\ RI VDOYDJH WKHUDS\ using high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after primary HIFU or external beam radiotherapy (EBRT).
Introduction & Objectives: HIFU represents a potential treatment for locally recurrent prostate cancer after EBRT. We evaluated the prognostic factors for disease progression after salvage HIFU.
Material & Methods: %HWZHHQ2FWREHUDQG0D\DWRWDORISDWLHQWVZLWK locally recurrent prostate cancer after primary treatment (HIFU 21 patients, EBRT 9 patients) underwent salvage HIFU with the Ablatherm HIFU device. Local recurrence DIWHUSULPDU\WUHDWPHQWZDVGHᚏQHGDVWKHSUHVHQFHRIDFDQFHUUHPQDQWRQUHSHDWHG biopsies or three consecutive increase in the PSA >1.0ng/ml. We reviewed clinical data and evaluated the prognostic value of clinical parameters to predict success of salvage HIFU.
Material & Methods: 167 patients, mean age 68.9, underwent salvage HIFU. All had biopsy-proven local recurrence and no detectable metastasis. HIFU were delivered under spinal anesthesia using the Ablatherm HIFU devices. Follow-up included serial 36$ PHDVXUHPHQWV V\VWHPDWLF FRQWURO ELRSVLHV PRQWKV SRVW +,)8 DQG DGGLWLRQDO ELRSVLHVLQFDVHRIULVLQJ36$'LVHDVHSURJUHVVLRQZDVGHᚏQHGDVDQLQFUHDVHLQQJ ml or more above the PSA nadir, a positive biopsy or a salvage therapy introduction 3KHQL[$6752FRQVHQVXV 7KHSURJUHVVLRQIUHHVXUYLYDOUDWH 3)65 ZDVVWUDWLᚏHG according to the pre-HIFU Gleason score and PSA level, the pre-HIFU positive biopsy percentage, the pre RT D’Amico’s risk score, and the administration of androgen deprivation (AD) at the time of EBRT or between recurrence and HIFU. Univariate and multivariate analysis were calculated using Kaplan-Meier curves and Cox Model, respectively.
Results: 7KH EDVHOLQH FKDUDFWHULVWLFV EHIRUH VDOYDJH +,)8 ZHUH PHDQ DJH s \HDUVPHGLDQ36$OHYHOQJP/ 0HGLDQWLPHWRQDGLU36$DQGQDGLU36$ OHYHODIWHUVDOYDJH+,)8ZHUHPRQWKV DQGQJP/ $IWHU PHGLDQIROORZXSRIPRQWKV UDQJHWR RIWKHSDWLHQWVKDG no evidence of biochemical recurrence and any disease progression. Among various clinical parameters, risk group (high risk, PSA>20 or Gleason score 8-10 or clinical stage u7D WLPHWRUHFXUUHQFHDIWHUSULPDU\WUHDWPHQW OHVVWKDQPRQWKV DQG36$QDGLU level after salvage HIFU (0.5ng/mL or above) associated with failure of salvage HIFU therapy on univariate analysis. But PSA nadir level after salvage HIFU therapy was the RQO\VLJQLᚏFDQWSUHGLFWRURQPXOWLYDULDWHDQDO\VLV &R[SURSRUWLRQDOKD]DUGPRGHO 7KH FRPSOLFDWLRQVRIVDOYDJH+,)8LQFOXGHGXUHWKUDOVWULFWXUHLQSDWLHQWVWUDQVLHQWXULQDU\ UHWHQWLRQDQGLQFRQWLQHQFHLQDQGSDWLHQWVWUDQVXUHWKUDOUHVHFWLRQRIQHFURWLFWLVVXH GHEULVLQSDWLHQWV Conclusions: This preliminary experience has demonstrated that salvage HIFU is HᚎHFWLYH WUHDWPHQW RSWLRQ IRU ORFDOO\ UHFXUUHQW SURVWDWH FDQFHU DIWHU SULPDU\ +,)8 RU EBRT. Morbidity related with salvage HIFU therapy was lower than other type of salvage WKHUDS\$QGORQJHUIROORZXSDQGODUJHUVHULHVRISDWLHQWVFRXOGKHOSWREHWWHUGHᚏQHWKH results of salvage HIFU therapy.
Edouard Herriot Hospital, Dept. of Urology, Lyon, France, 2Edouard Herriot Hospital, Dept. of Radiology, Lyon, France, Edouard Herriot Hospital, Dept. of Pathology, Lyon, France, 4INSERM, Unit 556, Lyon, France
Results: 0HDQ)ROORZXSZDVPRQWKV 6\VWHPDWLFFRQWUROELRSVLHVZHUH QHJDWLYHLQZLWKDPHGLDQ36$QDGLURI QJPO7KHRYHUDOODFWXDULDO\HDU survival rate was 84% (74-94%). PFSR was inversely related with the pre-RT risk OHYHO S ZLWKDQGDW\HDUVIRUORZLQWHUPHGLDWHDQGKLJKULVN SDWLHQWVUHVSHFWLYHO\3)65ZDVVLJQLᚏFDQWO\ORZHU S LQSDWLHQWVZKRUHFHLYHG $' HYHQ RQFH VWUDWLᚏHG RQ 'ಬ$PLFRಬV ULVN OHYHOV S 1HLWKHU WKH *OHDVRQ VXP S QRU WKH SRVLWLYH ELRSV\ SHUFHQWDJH S GLG LQᚐXHQFH WKH 3)65 ,Q multivariate analysis, the risk ratio for high and intermediate risk patients was 1.96 and UHVSHFWLYHO\,WZDVZKHQ$'ZDVXVHG Conclusions: 3DWLHQWVPRVWOLNHO\WREHQHᚏWIURPD+,)8VDOYDJHWKHUDS\KDYHSUH57 ORZRULQWHUPHGLDWHGLVHDVH7KHSUH+,)8ELRSV\LQIRUPDWLRQಬVKDYHQRLQᚐXHQFHRQ WKH +,)8 HᚑFDF\ 6XUSULVLQJO\ SDWLHQW KRUPRQDOO\ QDLYH DUH PXFK EHWWHU UHVSRQGHU than others.
195 TREATMENT OF LOCALISED PROSTATE CANCER BY HIGH INTENSITY FOCUSED ULTRASOUND (HIFU); RESULTS OF THE FIRST FRENCH PROSPECTIVE STUDY ON PATIENTS NOT PREVIOUSLY TREATED: MINIMUM OF FIVE YEARS OF FOLLOW-UP. Conort P.1, Rischmann P.2, Bensadoun H. 3ᚏVWHU &4, Chevalier D.5, Saussine C.6, Vallancien G.7, Gelet A.8 Pitie-Salpetriere, Dept. of Urology, Paris, France, 2Toulouse, Dept. of Urology, Toulouse, France, Caen, Dept. of Urology, Caen, France, 4Rouen, Dept. of Urology, Rouen, France, 5 Nice, Dept. of Urology, Nice, France, 6Strasbourg, Dept. of Urology, Strasbourg, France, 7 Montsouris, Dept. of Urology, Paris, France, 8Herriot, Dept. of Urology, Lyon, France 1
Introduction & Objectives: HYDOXDWHHᚑFDF\RIRQHRUWZRVHVVLRQVRI+,)8 $EODWKHUP®) DV WKH ᚏUVW OLQH WUHDWPHQW QR KRUPRQH EHIRUH IRU ORFDOLVHG SURVWDWH FDQFHU 3&D E\ with a minimum of 5 years of follow-up (FU): prospective multicentre study conducted by Association Française d’Urologie (AFU). Material & Methods: using Ablatherm® (EDAP S.A., CE mark on 2000), from 25/01/01 to 25/01/02, 8 urological Centres have included patients with strict criteria: PSA<15 ng/ mL, Score de Gleason (GS) <8, <50% of positive biopsies, volume prostate volume (PV) < 50 cc, stageT1b- c & T2. Data management and analysis were done by an independent institution (ITEC). Results: 117 patients (68 T1, 49 T2) were included : mean age 69 years (47-79), PSA sQJP/ sSRVLWLYHELRSVLHVIURPs*6s 39sFF (12-50). Sessions of HIFU: 179. Retreatment = 52%: 2 sessions for 56 patients (47%), IRU 1LQH SDWLHQWV GLHG QRQ &D UHODWHG DW PRQWKV RQO\ RQH XQGHU KRUPRQH DIWHUVHVVLRQV(OHYHQ ZHUHORVWRIIROORZXS DIWHUVHVVLRQV)URP WKHUHPDLQLQJ SDWLHQWV KDYHUHTXLUHGVHVVLRQV PHDQGHOD\sPRQWKV KDYHIDLOHG RWKHUWUHDWPHQW UDGLRWKHUDSLHV QRPDMRUFRPSOLFDWLRQ +RUPRQH WSURVWDWHFWRP\:LWKDPHDQ)8RIPRQWKVSDWLHQWVZHUHWUHDWHGE\+,)8DORQH UHWUHDWPHQW ZLWKDPHDQ36$ sQJP/ HW :LWKPRUHWKDQ 5 years of FU, 55 patients (75% of those without adjuvant treatment) were considered as VXFFHVV,QLWLDO36$LVQRWDSURQRVWLFIDFWRUEXW36$QDGLUDIWHUWKHᚏUVWVHVVLRQVHHPVWR EHUHODWHGWRVXFFHVV VXFFHVVIURPSDWLHQWVZLWK36$QDGLU QJP/ Conclusions: WKLVᚏUVWSURVSHFWLYHVWXG\!\HDUVRI)8KDVVKRZQWKDW+,)8 $EODWKHUP®) ZLWK D UHWUHDWPHQW UDWH RI FDQ VXFFHVVIXOO\ WUHDW PRUH WKDQ RI SDWLHQW ZLWKRXW DQ\PDMRUVLGHHᚎHFWV DGMXYDQWWUHDWPHQWZDVUHTXLUHGIRUZLWKJRRGWROHUDQFHDQG success. No disease related death was reported. Long term FU of the remaining 97 patients is going on.
196 FACTORS PREDICTING THE FORMATION OF BLADDER OUTLET OBSTRUCTION AFTER HIGH-INTENSITY FOCUSSED ULTRASOUND (HIFU) TREATMENT OF LOCALISED PROSTATE CANCER Ganzer R.1, Hierl J.1, Rogenhofer S.1, Lunz J.C.1, Walter B.1, Bach T.2, Wieland W.F.1, Blana A.1 University of Regensburg, Dept. of Urology, Regensburg, Germany, 2Asklepios Hospital Barmbek, Dept. of Urology, Hamburg, Germany
1
Introduction & Objectives: HIFU has established itself as a minimally invasive treatment option for localized prostate cancer. The most common adverse event is the formation of bladder outlet obstruction (BOO) during follow-up. Purpose of this study was a detailed DQDO\VLVRISRWHQWLDOIDFWRUVLQᚐXHQFLQJWKHRFFXUUHQFHRI%22DIWHU+,)8 Material & Methods: Patients were treated at our institution between November 1997 and April 2006 with the Ablatherm device (EDAP, Lyon) and followed-up every three months. Patients with a minimum follow-up of one year were analysed retrospectively. The type of %22ZDVFODVVLᚏHGLQWR EODGGHUQHFN %1 QHFURVLVRIWKHSURVWDWH 13 GLVWDOVWHQRVLV (DS) and urethral stenosis (US). Furthermore, we distinguished between single and multiple BOO. The following parameters were evaluated as independent factors: risk group (AJCC), age, prostate volume before HIFU, treated prostate volume by HIFU, whether or not a pre HIFU transurethral resection of the prostate (TURP) was performed, ratio of resected volume/ initial prostate volume for those who underwent pre HIFU TURP and time point of TURP prior to HIFU. For statistical analysis the parametric t–test was used for quantitative variables, the Mann-Whitney-U test for non–parametric variables. Categorical variables were compared by WKHFKLದVTXDUHWHVW3YDOXHVRI ZHUHFRQVLGHUHGVWDWLVWLFDOO\VLJQLᚏFDQW Results: SDWLHQWVZHUHDYDLODEOHIRUDQDO\VLV0HDQDJHZDVs\HDUV0HDQIROORZ up after HIFU was 40+19 (12–109) months. 79 (25.1%) of patients developed BOO during IROORZXS SDWLHQWVZLWKPXOWLSOH%22 0HDQWLPHWRᚏUVW%22ZDV PRQWKV 7KHGLVWULEXWLRQRIVLQJOH%22IRU%113'6DQG86ZDV and 10 (12.7%) respectively. In multiple BOO the main type of obstruction was BN. In single %22KLJKDJHDW+,)8ZDVDVVRFLDWHGZLWKDVLJQLᚏFDQWO\KLJKHUREVWUXFWLRQUDWH S $OORWKHUSDUDPHWHUVHYDOXDWHGZHUHZLWKRXWVWDWLVWLFDOO\VLJQLᚏFDQFH$VLJQLᚏFDQWO\ORZHU rate of multiple BOO was observed if the percentage of resected tissue in patients with a 7853SULRUWR+,)8ZDVKLJKHU S Conclusions: 7KHRFFXUUHQFHRI%22DIWHU+,)8LVVWDWLVWLFDOO\VLJQLᚏFDQWO\DVVRFLDWHGZLWK higher age. Surprisingly TURP prior to HIFU is not an independent factor to prevent BOO during follow-up. However, the occurrence of multiple BOO can be reduced by resecting more tissue with TURP prior to HIFU.
Eur Urol Suppl 2008;7(3):119
194 PROGNOSTIC FACTORS FOR SALVAGE HIFU SUCCESS AFTER EXTERNAL BEAM RADIATION FAILURE (EBRT) FAILURE
Seo S.I.1, Jeon S.S.1, Jo M.K.2, Lee H.M.1, Choi H.Y.1
Murat F.J.1, Poissonnier L.1, Pricaz E.1, Rouviere O.2, Mege F., Chapelon J.Y.4, Colombel M.1, Gelet A.1
1
Samsung Medical Centre, Sungkyunkwan University School of Medicine, Dept. of Urology, Seoul, South Korea, 2Korea Cancer Centre Hospital, Dept. of Urology, Seoul, South Korea
1
Introduction & Objectives: 7R HYDOXDWH WKH HᚑFDF\ DQG VDIHW\ RI VDOYDJH WKHUDS\ using high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after primary HIFU or external beam radiotherapy (EBRT).
Introduction & Objectives: HIFU represents a potential treatment for locally recurrent prostate cancer after EBRT. We evaluated the prognostic factors for disease progression after salvage HIFU.
Material & Methods: %HWZHHQ2FWREHUDQG0D\DWRWDORISDWLHQWVZLWK locally recurrent prostate cancer after primary treatment (HIFU 21 patients, EBRT 9 patients) underwent salvage HIFU with the Ablatherm HIFU device. Local recurrence DIWHUSULPDU\WUHDWPHQWZDVGHᚏQHGDVWKHSUHVHQFHRIDFDQFHUUHPQDQWRQUHSHDWHG biopsies or three consecutive increase in the PSA >1.0ng/ml. We reviewed clinical data and evaluated the prognostic value of clinical parameters to predict success of salvage HIFU.
Material & Methods: 167 patients, mean age 68.9, underwent salvage HIFU. All had biopsy-proven local recurrence and no detectable metastasis. HIFU were delivered under spinal anesthesia using the Ablatherm HIFU devices. Follow-up included serial 36$ PHDVXUHPHQWV V\VWHPDWLF FRQWURO ELRSVLHV PRQWKV SRVW +,)8 DQG DGGLWLRQDO ELRSVLHVLQFDVHRIULVLQJ36$'LVHDVHSURJUHVVLRQZDVGHᚏQHGDVDQLQFUHDVHLQQJ ml or more above the PSA nadir, a positive biopsy or a salvage therapy introduction 3KHQL[$6752FRQVHQVXV 7KHSURJUHVVLRQIUHHVXUYLYDOUDWH 3)65 ZDVVWUDWLᚏHG according to the pre-HIFU Gleason score and PSA level, the pre-HIFU positive biopsy percentage, the pre RT D’Amico’s risk score, and the administration of androgen deprivation (AD) at the time of EBRT or between recurrence and HIFU. Univariate and multivariate analysis were calculated using Kaplan-Meier curves and Cox Model, respectively.
Results: 7KH EDVHOLQH FKDUDFWHULVWLFV EHIRUH VDOYDJH +,)8 ZHUH PHDQ DJH s \HDUVPHGLDQ36$OHYHOQJP/ 0HGLDQWLPHWRQDGLU36$DQGQDGLU36$ OHYHODIWHUVDOYDJH+,)8ZHUHPRQWKV DQGQJP/ $IWHU PHGLDQIROORZXSRIPRQWKV UDQJHWR RIWKHSDWLHQWVKDG no evidence of biochemical recurrence and any disease progression. Among various clinical parameters, risk group (high risk, PSA>20 or Gleason score 8-10 or clinical stage u7D WLPHWRUHFXUUHQFHDIWHUSULPDU\WUHDWPHQW OHVVWKDQPRQWKV DQG36$QDGLU level after salvage HIFU (0.5ng/mL or above) associated with failure of salvage HIFU therapy on univariate analysis. But PSA nadir level after salvage HIFU therapy was the RQO\VLJQLᚏFDQWSUHGLFWRURQPXOWLYDULDWHDQDO\VLV &R[SURSRUWLRQDOKD]DUGPRGHO 7KH FRPSOLFDWLRQVRIVDOYDJH+,)8LQFOXGHGXUHWKUDOVWULFWXUHLQSDWLHQWVWUDQVLHQWXULQDU\ UHWHQWLRQDQGLQFRQWLQHQFHLQDQGSDWLHQWVWUDQVXUHWKUDOUHVHFWLRQRIQHFURWLFWLVVXH GHEULVLQSDWLHQWV Conclusions: This preliminary experience has demonstrated that salvage HIFU is HᚎHFWLYH WUHDWPHQW RSWLRQ IRU ORFDOO\ UHFXUUHQW SURVWDWH FDQFHU DIWHU SULPDU\ +,)8 RU EBRT. Morbidity related with salvage HIFU therapy was lower than other type of salvage WKHUDS\$QGORQJHUIROORZXSDQGODUJHUVHULHVRISDWLHQWVFRXOGKHOSWREHWWHUGHᚏQHWKH results of salvage HIFU therapy.
Edouard Herriot Hospital, Dept. of Urology, Lyon, France, 2Edouard Herriot Hospital, Dept. of Radiology, Lyon, France, Edouard Herriot Hospital, Dept. of Pathology, Lyon, France, 4INSERM, Unit 556, Lyon, France
Results: 0HDQ)ROORZXSZDVPRQWKV 6\VWHPDWLFFRQWUROELRSVLHVZHUH QHJDWLYHLQZLWKDPHGLDQ36$QDGLURI QJPO7KHRYHUDOODFWXDULDO\HDU survival rate was 84% (74-94%). PFSR was inversely related with the pre-RT risk OHYHO S ZLWKDQGDW\HDUVIRUORZLQWHUPHGLDWHDQGKLJKULVN SDWLHQWVUHVSHFWLYHO\3)65ZDVVLJQLᚏFDQWO\ORZHU S LQSDWLHQWVZKRUHFHLYHG $' HYHQ RQFH VWUDWLᚏHG RQ 'ಬ$PLFRಬV ULVN OHYHOV S 1HLWKHU WKH *OHDVRQ VXP S QRU WKH SRVLWLYH ELRSV\ SHUFHQWDJH S GLG LQᚐXHQFH WKH 3)65 ,Q multivariate analysis, the risk ratio for high and intermediate risk patients was 1.96 and UHVSHFWLYHO\,WZDVZKHQ$'ZDVXVHG Conclusions: 3DWLHQWVPRVWOLNHO\WREHQHᚏWIURPD+,)8VDOYDJHWKHUDS\KDYHSUH57 ORZRULQWHUPHGLDWHGLVHDVH7KHSUH+,)8ELRSV\LQIRUPDWLRQಬVKDYHQRLQᚐXHQFHRQ WKH +,)8 HᚑFDF\ 6XUSULVLQJO\ SDWLHQW KRUPRQDOO\ QDLYH DUH PXFK EHWWHU UHVSRQGHU than others.
195 TREATMENT OF LOCALISED PROSTATE CANCER BY HIGH INTENSITY FOCUSED ULTRASOUND (HIFU); RESULTS OF THE FIRST FRENCH PROSPECTIVE STUDY ON PATIENTS NOT PREVIOUSLY TREATED: MINIMUM OF FIVE YEARS OF FOLLOW-UP. Conort P.1, Rischmann P.2, Bensadoun H. 3ᚏVWHU &4, Chevalier D.5, Saussine C.6, Vallancien G.7, Gelet A.8 Pitie-Salpetriere, Dept. of Urology, Paris, France, 2Toulouse, Dept. of Urology, Toulouse, France, Caen, Dept. of Urology, Caen, France, 4Rouen, Dept. of Urology, Rouen, France, 5 Nice, Dept. of Urology, Nice, France, 6Strasbourg, Dept. of Urology, Strasbourg, France, 7 Montsouris, Dept. of Urology, Paris, France, 8Herriot, Dept. of Urology, Lyon, France 1
Introduction & Objectives: HYDOXDWHHᚑFDF\RIRQHRUWZRVHVVLRQVRI+,)8 $EODWKHUP®) DV WKH ᚏUVW OLQH WUHDWPHQW QR KRUPRQH EHIRUH IRU ORFDOLVHG SURVWDWH FDQFHU 3&D E\ with a minimum of 5 years of follow-up (FU): prospective multicentre study conducted by Association Française d’Urologie (AFU). Material & Methods: using Ablatherm® (EDAP S.A., CE mark on 2000), from 25/01/01 to 25/01/02, 8 urological Centres have included patients with strict criteria: PSA<15 ng/ mL, Score de Gleason (GS) <8, <50% of positive biopsies, volume prostate volume (PV) < 50 cc, stageT1b- c & T2. Data management and analysis were done by an independent institution (ITEC). Results: 117 patients (68 T1, 49 T2) were included : mean age 69 years (47-79), PSA sQJP/ sSRVLWLYHELRSVLHVIURPs*6s 39sFF (12-50). Sessions of HIFU: 179. Retreatment = 52%: 2 sessions for 56 patients (47%), IRU 1LQH SDWLHQWV GLHG QRQ &D UHODWHG DW PRQWKV RQO\ RQH XQGHU KRUPRQH DIWHUVHVVLRQV(OHYHQ ZHUHORVWRIIROORZXS DIWHUVHVVLRQV)URP WKHUHPDLQLQJ SDWLHQWV KDYHUHTXLUHGVHVVLRQV PHDQGHOD\sPRQWKV KDYHIDLOHG RWKHUWUHDWPHQW UDGLRWKHUDSLHV QRPDMRUFRPSOLFDWLRQ +RUPRQH WSURVWDWHFWRP\:LWKDPHDQ)8RIPRQWKVSDWLHQWVZHUHWUHDWHGE\+,)8DORQH UHWUHDWPHQW ZLWKDPHDQ36$ sQJP/ HW :LWKPRUHWKDQ 5 years of FU, 55 patients (75% of those without adjuvant treatment) were considered as VXFFHVV,QLWLDO36$LVQRWDSURQRVWLFIDFWRUEXW36$QDGLUDIWHUWKHᚏUVWVHVVLRQVHHPVWR EHUHODWHGWRVXFFHVV VXFFHVVIURPSDWLHQWVZLWK36$QDGLU QJP/ Conclusions: WKLVᚏUVWSURVSHFWLYHVWXG\!\HDUVRI)8KDVVKRZQWKDW+,)8 $EODWKHUP®) ZLWK D UHWUHDWPHQW UDWH RI FDQ VXFFHVVIXOO\ WUHDW PRUH WKDQ RI SDWLHQW ZLWKRXW DQ\PDMRUVLGHHᚎHFWV DGMXYDQWWUHDWPHQWZDVUHTXLUHGIRUZLWKJRRGWROHUDQFHDQG success. No disease related death was reported. Long term FU of the remaining 97 patients is going on.
196 FACTORS PREDICTING THE FORMATION OF BLADDER OUTLET OBSTRUCTION AFTER HIGH-INTENSITY FOCUSSED ULTRASOUND (HIFU) TREATMENT OF LOCALISED PROSTATE CANCER Ganzer R.1, Hierl J.1, Rogenhofer S.1, Lunz J.C.1, Walter B.1, Bach T.2, Wieland W.F.1, Blana A.1 University of Regensburg, Dept. of Urology, Regensburg, Germany, 2Asklepios Hospital Barmbek, Dept. of Urology, Hamburg, Germany
1
Introduction & Objectives: HIFU has established itself as a minimally invasive treatment option for localized prostate cancer. The most common adverse event is the formation of bladder outlet obstruction (BOO) during follow-up. Purpose of this study was a detailed DQDO\VLVRISRWHQWLDOIDFWRUVLQᚐXHQFLQJWKHRFFXUUHQFHRI%22DIWHU+,)8 Material & Methods: Patients were treated at our institution between November 1997 and April 2006 with the Ablatherm device (EDAP, Lyon) and followed-up every three months. Patients with a minimum follow-up of one year were analysed retrospectively. The type of %22ZDVFODVVLᚏHGLQWR EODGGHUQHFN %1 QHFURVLVRIWKHSURVWDWH 13 GLVWDOVWHQRVLV (DS) and urethral stenosis (US). Furthermore, we distinguished between single and multiple BOO. The following parameters were evaluated as independent factors: risk group (AJCC), age, prostate volume before HIFU, treated prostate volume by HIFU, whether or not a pre HIFU transurethral resection of the prostate (TURP) was performed, ratio of resected volume/ initial prostate volume for those who underwent pre HIFU TURP and time point of TURP prior to HIFU. For statistical analysis the parametric t–test was used for quantitative variables, the Mann-Whitney-U test for non–parametric variables. Categorical variables were compared by WKHFKLದVTXDUHWHVW3YDOXHVRI ZHUHFRQVLGHUHGVWDWLVWLFDOO\VLJQLᚏFDQW Results: SDWLHQWVZHUHDYDLODEOHIRUDQDO\VLV0HDQDJHZDVs\HDUV0HDQIROORZ up after HIFU was 40+19 (12–109) months. 79 (25.1%) of patients developed BOO during IROORZXS SDWLHQWVZLWKPXOWLSOH%22 0HDQWLPHWRᚏUVW%22ZDV PRQWKV 7KHGLVWULEXWLRQRIVLQJOH%22IRU%113'6DQG86ZDV and 10 (12.7%) respectively. In multiple BOO the main type of obstruction was BN. In single %22KLJKDJHDW+,)8ZDVDVVRFLDWHGZLWKDVLJQLᚏFDQWO\KLJKHUREVWUXFWLRQUDWH S $OORWKHUSDUDPHWHUVHYDOXDWHGZHUHZLWKRXWVWDWLVWLFDOO\VLJQLᚏFDQFH$VLJQLᚏFDQWO\ORZHU rate of multiple BOO was observed if the percentage of resected tissue in patients with a 7853SULRUWR+,)8ZDVKLJKHU S Conclusions: 7KHRFFXUUHQFHRI%22DIWHU+,)8LVVWDWLVWLFDOO\VLJQLᚏFDQWO\DVVRFLDWHGZLWK higher age. Surprisingly TURP prior to HIFU is not an independent factor to prevent BOO during follow-up. However, the occurrence of multiple BOO can be reduced by resecting more tissue with TURP prior to HIFU.
Eur Urol Suppl 2008;7(3):119