High-intensity focused ultrasound for the treatment of low-risk organ confined prostate cancer: Initial experience from a single UK centre

ment. Per risk group we noticed that mean PSA (mPSA) stayed ⬍ 0.5 ng/ml during the entire follow-up period for the low risk group (100% PSA ⬍ 1 ng/ml), mPSA ⬍ 1 ng/ml for the intermediate risk group (⬎ 90% PSA ⬍ 1 ng/ml) and mPSA ⬍ 1.5 ng/ml for the high risk group (⬎ 80% PSA ⬍ 1 ng/ml). In the T3a group more than 75% of patients kept a PSA ⬍ 1 ng/ml. No major complications were seen, urethral or bladder neck stricture or sloughing was seen in 8% of patients. Temporary stress I-II / urge incontinence was seen in 14% of patients, recovering within 3 months in 98% of them. Potency preservation was possible in ⬎ 75% of patients who had a unilateral nerve-sparing treatment in all risk groups, ⬎ 30% in the completely treated patients and 8% in the T3 group (extension of the treatment well beyond the capsula). Conclusions: HIFU proves to be a safe, minimally invasive and possibly curative treatment option for patients with localized prostate cancer. Retreatment after EBRT-failure remains a safe option. Continued monitoring of follow-up studies is mandatory. 27

High-intensity focused ultrasound for the treatment of lowrisk organ confined prostate cancer: Initial experience from a single UK centre Kennedy J, Leslie T, Brewster SF, Sullivan M Churchill Hospital, Oxford, UK Introduction: High-intensity focused ultrasound (HIFU) has been investigated as a clinical tool for the treatment of organconfined prostate cancer for over ten years. Short-term results from several pioneering centres appear very promising although long-term efficacy remains to be clarified. Another important consideration regarding the acceptability of a new technique relates to the wider reproducibility of safety data and results. To date, HIFU has been used in the UK for one year as a prostate cancer treatment, in three separate centres. In this context, we report the initial experience of a single centre. Methods: Since March 2005, as part of an ongoing prospective multi-centre phase 2 clinical investigation, patients with T1 or T2 prostate cancer have been treated with the Sonablate 500 transrectal HIFU device. Principal inclusion criteria are as follows: PSA ⬍ 15; prostate volume ⬍ 40 cm3, Gleason sum score ⱕ 7. Outcome measures include serial assessment of: serum PSA values; lower urinary tract symptoms (IPSS); erectile function (IIEF); adverse events and continence. Results and Conclusions: At the time of submission, three patients have been treated without significant immediate complications, each in a single session under general anaesthesia. Interim results including six-month follow-up data will be presented. 28

Ultrasonido de alta intensidad en el tratamiento del adenocarcinoma prostatico localizado en el paciente con trasplante renal o pre-trasplante Lledo-Garcia E1, Jara-Rascon J1, Pedemonte G1, Anaya Fernandez De Lomana F2, Hernandez Fernandez C1 Servicios de 1Urologia y 2Nefrologia, Hospital General Universitario Gregorio Maran˜on, Madrid, Espan˜a Introduccio´n: El tratamiento del ca´ncer prosta´tico localizado (Cap-l) en el paciente candidato a trasplante renal (TR) o con TR funcionante puede suponer un problema clı´nico de manejo UROLOGY 66 (Supplement 3A), September 2005

complejo. No se conoce el efecto de la radioterapia prosta´tica en el injerto renal. Por otro lado, la realizacio´n de prostatectomı´a radical retropu´bica (PRRP) puede ser muy dificultosa en pacientes con TR, o producir importante fibrosis en el candidato futuro a TR. Objetivo: Plantear el Ultrasonido de Alta Intensidad (HIFU) por vı´a transrectal como una terapia menos invasiva eficaz en el tratamiento del Cap-l en el paciente candidato a TR o con TR funcionante. Material y Me´todo: Caso 1: paciente de 62 an˜os, portador de TR funcionante. Inmunosupresio´n (IS) con tacrolimus, prednisona. Se realiza ecografı´a prosta´tica transrectal (TRUS) con biopsia por elevacio´n de PSA en revisio´n rutinaria (6 ngrs/mlratio 15%). Pro´stata 23 cc, ecoestructura capsular conservada. Anatomı´a Patolo´gica: Cap Gleason Score 7 en lo´bulo izquierdo, PIN-3 en lo´bulo derecho. Caso 2: paciente de 56 an˜os, insuficiencia renal cro´nica secundaria a glomerulonefritis. Deteccio´n de PSA elevado en estudio pre-trasplante (PSA 8 ngrs/ ml-ratio 13%). Se realiza TRUS (pro´stata de 32 cc) con biopsia prosta´tica: Cap Gleason Score 7 bilateral. Estudio de estadiaje (TAC – gammagrafı´a o´sea) sin signos de extensio´n extraprosta´tica. Resultados: Se llevo´ a cabo en ambos casos reseccio´n transuretral prosta´tica seguida inmediatamente de HIFU (1 sesio´n completa/paciente). El tiempo medio operatorio fue de 132 minutos. No se produjo morbilidad perioperatoria ni postoperatoria. El tiempo medio de ingreso fue de 48 horas. En el seguimiento a medio plazo, la biopsia a 6 y 12 meses tras el tratamiento demostro´ en ambos casos ausencia de tejido tumoral, con presencia de focos de necrosis isque´mica e infiltrados inflamatorios. El PSA en ambos casos fue inferior a 0.04 ngrs/ml. No se suspendio´n en ningu´n momento la IS en el paciente trasplantado; el candidato a TR fue incluido en lista de espera. Conclusiones: Creemos que HIFU puede ser una alternativa va´lida en el tratamiento del Cap localizado en pacientes con injerto renal funcionante o candidatos a TR. Debe tenerse en cuenta esta opcio´n menos invasiva en los Programa de Trasplante Renal, teniendo en cuenta el incremento de la edad media de los pacientes.

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Unified theory of prostate cancer: the role of steroid 5 alpha reductase and steroid aromatase Pitts, Jr. W, Scherr D New York Presbyterian Hospital, New York, NY Introduction: Absent or minimal steroid 5 alpha reductase (S5AR) is the only constant finding in prostate cancer. A review of the biochemical, genetic, epigenetic, epidemiological, experimental, and pharmacological causes for low or absent steroid 5 alpha reductase (S5AR) in prostate cancer was undertaken to find a method to block the adverse effects of absent or minimal steroid 5 alpha reductase (S5AR). Methods: A library search of the biochemical, epidemiological and medical literature was employed. Results: Dihydrotestosterone (DHT) mediates cellular apoptosis of prostate glandular cells. Testosterone is the substrate for estrogen and estrogen stimulates proliferation of prostate glandular cells and prostate cancer cells. Steroid 5 alpha reductase (S5AR) converts testosterone (T) to dihydrotestosterone (DHT) and absent steroid 5 alpha reductase 11