高强度聚焦超声联合内分泌治疗前列腺癌

目的评价高强度聚焦超声(HIFU)联合内分泌治疗前列腺癌(PCa)的疗效和副作用。方法PCa患者65例,B期12例,C期32例,D期21例,平均PSA为(85.5±79.4)ng/ml;以HIFU联合内分泌治疗,随访PSA和1、3、5年生存率,观察治疗的副作用。结果55例获得12～46个月的随访;术后3个月平均PSA为(53.4±51.3)ng/ml,与术前相比具有显著性差异(P<0.01),患者1、3、5年生存率分别为87.2%、38.2%和23.6%,副作用轻微。结论HIFU联合内分泌治疗前列腺癌能有效地降低PSA,提高患者生存率,具有高度安全性。     

经直肠高强度聚焦超声系统治疗前列腺癌57例疗效分析

目的:探讨经直肠高强度聚焦超声系统(HIFU)治疗PCa的疗效。方法:使用Sonablate500型经直肠HIFU治疗系统,对57例PCa患者进行HIFU治疗,其中局限性PCa27例,晚期PCa30例。在确定生化复发之前,对局限性PCa仅行经直肠HIFU治疗;对于晚期PCa,在行经直肠HIFU治疗的同时,联合应用内分泌治疗。结果:HIFU治疗平均手术操作时间为111(86～153)min,平均术后住院时间为3.2(2～18)d。平均随访时间18(6～30)个月。局限性PCaHIFU治疗后,生化检查阴性率(PSA(4.0μg/L)在治疗后的1、2、3年分别为86%、81%和79%。30例晚期PCa治疗平均8个月(3～24个月)后,26例血清PSA<4.0μg/L(其中20例血清PSA<0.5μg/L)、21例患者前列腺体积缩小>50%。治疗后6个月时与治疗前相比,前列腺体积缩小、PSA水平降低、Qmax增加及IPSS改善差异均有显著性(P<0.05)。HIFU治疗后无严重尿道直肠瘘、尿失禁等并发症发生。结论:经直肠HIFU治疗PCa,安全、有效,并发症少,近期疗效较好,是一种可选择的PCa微创治疗方法。     

经直肠高强度聚焦超声系统治疗前列腺癌57例疗效分析

目的：探讨经直肠高强度聚焦超声系统（HIFU）治疗PCa的疗效。方法：使用Sonablate500型经直肠HIFU治疗系统,对57例PCa患者进行HIFU治疗,其中局限性PCa27例,晚期PCa30例。在确定生化复发之前,对局限性PCa仅行经直肠HIFU治疗;对于晚期PCa,在行经直肠HIFU治疗的同时,联合应用内分泌治疗。结果：HIFU治疗平均手术操作时间为111（86～153）min,平均术后住院时间为3.2（2～18）d。平均随访时间18（6～30）个月。局限性PCaHIFU治疗后,生化检查阴性率（PSA（4.0μg/L）在治疗后的1、2、3年分别为86%、81%和79%。30例晚期PCa治疗平均8个月（3～24个月）后,26例血清PSA〈4.0μg/L（其中20例血清PSA〈0.5μg/L）、21例患者前列腺体积缩小〉50%。治疗后6个月时与治疗前相比,前列腺体积缩小、PSA水平降低、Qmax增加及IPSS改善差异均有显著性（P〈0.05）。HIFU治疗后无严重尿道直肠瘘、尿失禁等并发症发生。结论：经直肠HIFU治疗PCa,安全、有效,并发症少,近期疗效较好,是一种可选择的PCa微创治疗方法。     

高强度聚焦超声联合内分泌综合治疗前列腺癌34例临床分析

目的评价应用高强度聚焦超声和内分泌治疗的综合治疗方案在前列腺癌治疗中的临床效果。方法对34例前列腺癌患者联合应用高强度聚焦超声和内分泌治疗,观察和统计治疗前后血前列腺特异性抗原、前列腺体积、前列腺彩超以及前列腺穿刺活检结果的变化,调查治疗后并发症的发生情况。结果34例患者治疗后血前列腺特异性抗原PSA（14．6±13．1）ng／mL,与治疗前（35．7±14．6）ng／mL相比,具有统计学显著性差异（P〈0．05）。前列腺体积治疗前（49．7±21．3）cm。,治疗后（42．1土11．6）cm^3,两者无统计学差异（P〉0．05）。前列腺再穿刺阴性率68．4％（13／19）患者前列腺再穿刺阴性。26例（76．5％）患者在拔除尿管后出现尿频、尿痛等排尿不适症状。11例（32．3％）出现轻度的血尿。结论联合应用高强度聚焦超声和内分泌治疗的综合治疗方案能有效地降低前列腺癌患者的PSA,临床治疗效果肯定,并发症少,安全性好,是一种比较合理的前列腺癌治疗方案。     

高能聚焦超声联合内分泌疗法治疗前列腺癌

目的: 探讨高能聚焦超声(HIFU)联合内分泌疗法治疗前列腺癌的疗效。　方法: 对 20例前列腺癌患者行HIFU+内分泌治疗,HIFU治疗采用FEP BY01型高能聚焦超声肿瘤治疗机;内分泌治疗采用手术去势 15例,药物去势(LHRH a)5例,其中 14例加用抗雄激素药物。随访时间 6~30个月,平均16. 5个月。　结果: 治疗前后前列腺体积分别为(36. 4± 16. 2)、(20. 6±11. 8)ml(P<0. 05);血清前列腺特异性抗原值为 (32. 2±10. 4)、(2. 4±0. 8)μg/L(P<0. 01);国际前列腺症状评分为 (20. 5±6. 5)、(13. 6±7. 5 )分 (P<0. 05 );最大尿流率为 ( 10. 6±6. 3)、(14. 2±4. 6)ml/s(P<0. 05 )。HIFU治疗并发症:轻度血尿 5例,局部疼痛 8例,尿道狭窄 1例。　结论:HIFU联合内分泌疗法治疗前列腺癌并发症少,近期疗效较好。     

高强度聚焦超声联合低剂量放疗作为进展期前列腺癌内分泌治疗后补充治疗的有效性和安全性分析

本研究旨在评估高强度聚焦超声（high-intensity focused ultrasound,HIFU）联合（＋）低剂量外放疗（low—dose external beam radiotherapy,LRT）作为进展期前列腺癌内分泌治疗（hormonal therapy,HT）后补充治疗的有效性和安全性。我们定义的HIFU＋LRT是指采用HIFU治疗前列腺癌原发灶,取代前列腺及精囊区的缩野外放疗,而仅保留传统外放疗（conventional—dose external beam radiotherapy,CRT）中盆腔的四野照射。我们对进展期前列腺癌内分泌治疗后的120例患者进行了非随机的前瞻性对照研究,分别接受HIFU、CRT、HIFU＋LRT、和单纯HT治疗。CT／MRI影像学检查显示HIFU＋LRT治疗后原发肿瘤和盆腔淋巴结转移灶明显萎缩甚至消失。四组间的总体和疾病特异生存曲线（P=0．018和O．015）均存在显著差异。进一步行各组两两比较提示HIFU＋LRT组的长期疾病特异生存率高于其它3组,但HIFU＋LRT组与CRT组的差异无显著性。多因素COX比例风险模型证实HIFU＋LRT和CRT均单独和DSS相关（P=O．001和O．035）,对死亡风险有显著保护作用。与cRT比较,HIFU＋LRT能显著减少放疗相关的远期泌尿道及消化道II级或以上严重并发症的发生率。总而言之,进展期前列腺癌采用内分泌治疗后,进一步加强原发灶和区域淋巴结转移灶的治疗能有效提高患者的长期生存。作为替代常规剂量外放疗的选择之一,HIFU＋LRT显示了良好疗效和更高的安全性。     

经直肠高强度聚焦超声治疗局限性前列腺癌(附36例报告)

目的 总结经直肠高强度聚焦超声(high-intensity focused ultrasound,HIFU)治疗局限性前列腺癌的临床经验并评估其有效性及安全性. 方法 使用Sonablate-500聚焦超声系统对36例局限性前列腺癌患者进行治疗,观察患者治疗时耐受情况,监测治疗后3、6、12个月时的血清前列腺特异性抗原(PSA)、直肠指诊(DRE)、最大尿流率(Qmax)及经直肠前列腺B超情况,治疗后6～12个月行经直肠前列腺穿刺活检. 结果 平均手术操作时间41 min(25～76 min),平均术后住院时间3.4 d (2～9 d).治疗后3、6、12个月时PSA与治疗前相比均明显降低(P＜0.05),Qmax较治疗前均增加(P＜0.05),前列腺体积较治疗前均缩小(P＜0.05),DRE发现结节消失或减小的占77.8%(28/36),B超提示低回声结节消失或缩小的占83.3%(30/36).治疗后3、6、12个月各项检查结果差异无统计学意义(P>0.05). 结论 HIFU治疗前列腺癌具有微创、安全、痛苦少、效果好、恢复快和并发症少等优点,对于无法耐受根治性前列腺切除术的局限性前列腺癌患者可考虑行HIFU治疗.     

前列腺癌的高强度聚焦超声治疗

前列腺癌（prostate cancer，PCa）的流行病学显示，前列腺癌发病率正逐年增高。美国的前列腺癌发病率已超过肺癌，据美国抗癌协会估计，2004年美国大约有230110例新发前列腺癌，有29900例将死于此病。在欧洲，每年新发前列腺癌病例大约有260万人，前列腺癌病人占全部男性癌症病人数的11％，占全部男性癌症死亡人数的9％。     

经直肠高能聚焦超声治疗局部晚期前列腺癌的短期疗效分析(附23例报告)

随着前列腺癌(prostate cancer,PCa)诊治水平的提高,PCa的早期诊断已成为可能,通过根治性手术切除、根治性放疗及内分泌治疗等手段,早期PCa已不再是一种致死性疾病.然而对于局部晚期前列腺癌(locauy advanced prostate cancer,LAPC)的治疗仍存在争议,因此有必要探讨其他可能治疗方法.高能聚焦超声(high-intensity focused ultrasound,HIFU)是近年来出现的治疗前列腺疾病的新兴技术.     

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 T1-T2) cancer who were not suitable candidates for radical surgery underwent transfectal HIFU ablation with the Ablatherm 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 cm3, 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 > or = 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 cm3, 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.     

Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer

The literature concerning the efficacy and safety of transrectal high-intensity focused ultrasound (HIFU) for the treatment of localized prostate cancer still comprises a relatively small number of articles. The main studies have been published by four teams using an apparatus available in Europe for several years. The recently presented results of the European Multicentre Study and the study by Gelet and associates based on 242 patients with a follow-up of more than 1 year show that HIFU is a valid alternative for the management of welldifferentiated and moderately differentiated localized prostate cancer with an initial PSA 10 years. In two studies, the combination of transurethral resection of the prostate and HIFU limited the risk of postoperative urinary retention without inducing a higher complication rate. In a series of patients presenting recurrence after external-beam radiotherapy, HIFU was found to be a useful therapy, with >80% negative biopsies. The best indications for HIFU are men over the age of 65, those who are not candidates for radical prostatectomy, obese patients, or patients with comorbidities likely to make surgery more difficult. The learning curve for this technique is relatively short, between 10 and 15 patients, for urologists experienced in transrectal ultrasonography. One of the advantages of HIFU is that it can be repeated in the case of recurrence or to re-treat a prostatic site, it involves no radiation, and patients do not suffer from long-term irritative urinary symptoms.     

Transrectal high-intensity focused ultrasound for local treatment of prostate cancer: current role

Attractivity of robotic high intensity focused ultrasound (HIFU) is based largely on the non-invasive, extremely precise nature of this high-tech robotic therapy as well as its clean, radiation free, surgical, but nevertheless, bloodless character. Today, in urological oncology, HIFU is used clinically as a therapeutic tool for the treatment of prostate cancer. Experimentally it is investigated for therapeutic use in kidney and breast cancer. Transrectal treatment of localized prostate cancer with HIFU has been under investigation since the 1990s and it is meanwhile an actively used therapy for the disease in many urological departments worldwide. Since 2000 HIFU is mostly used in combination with transurethral resection of the prostate in order to reduce prostate gland size, to facilitate effective tissue destruction and to avoid side effects. Palliative and salvage indications as well as focal therapy of prostate cancer are under investigation to extend the spectrum of HIFU indications for non invasive prostate cancer therapy.     

Transrectal high-intensity focused ultrasound for the treatment of localized prostate cancer: Eight-year experience

Objective:   To report on the long-term results of high-intensity focused ultrasound in the treatment of localized prostate cancer.
Methods:   A total of 517 men with stage T1c–T3N0M0 prostate cancer treated with Sonablate devices (Focus Surgery, Indianapolis, IN, USA) between January 1999 and December 2007 were included in the study. Biochemical failure was defined according to the Phoenix definition (prostate-specific antigen nadir + 2 ng/mL).
Results:   The median follow-up period for all patients was 24.0 months (range, 2 to 88). The biochemical disease-free rate (BDFR) in all patients at 5 years was 72%. The BDFR in patients with stage T1c, T2a, T2b, T2c and T3 groups at 5 years were 74%, 79%, 72%, 24% and 33%, respectively ( P  < 0.0001). BDFR in patients in the low, intermediate and high-risk groups at 5 years were 84%, 64% and 45%, respectively ( P  < 0.0001). The BDFR in patients treated with or without neoadjuvant hormonal therapy at 7 years were 73% and 53% ( P  < 0.0001), respectively. In multivariate analysis, pretreatment prostate-specific antigen levels (hazard ratio 1.060; P  < 0.0001; 95% confidence interval 1.040–1.080), neoadjuvant hormonal therapy (hazard ratio 2.252; P  < 0.0001; 95% confidence interval 1.530–3.315) and stage ( P  = 0.0189) were demonstrated to be statistically significant variables. Postoperative erectile dysfunction was noted in 33 out of 114 (28.9%) patients who were preoperatively potent.
Conclusions:   High-intensity focused ultrasound therapy appears to be minimally invasive, efficacious and safe for patients with localized prostate cancer, particularly those with low- and intermediate-risk cancer.     

Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study

We report a multicenter trial with transrectal high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. A total of 72 consecutive patients with stage T1c-2NOM0 prostate cancer were treated using the Sonablate 500TM HIFU device (Focus Surgery, Indianapolis, USA). Biochemical recurrence was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology Consensus Panel. The median age and prostate specific antigen (PSA) level were 72 years and 8.10 ng/ml, respectively. The median follow-up period for all patients was 14.0 months. Biochemical disease-free survival rates in all patients at 1 and 2 years were 78% and 76%, respectively. Biochemical disease-free survival rates in patients with stage T1c, T2a and T2b groups at 2 years were 89, 67% and 40% (p = 0.0817). Biochemical disease-free survival rates in patients with Gleason scores of 2-4, 5-7 and 8-10 at 2 years were 88, 72% and 80% (p = 0.6539). Biochemical disease-free survival rates in patients with serum PSA of less than 10 ng/ml and 10-20 ng/ml were 75% and 78% (p = 0.6152). No viable tumor cells were noted in 68% of patients by postoperative prostate needle biopsy. Prostatic volume was decreased from 24.2 ml to 14.0 ml at 6 months after HIFU (p < 0.01). No statistically significant differences were noted in International Prostate Symptom Score, maximum urinary flow rate and quality of life analysis with Functional Assessment of Cancer Therapy. HIFU therapy appears to be minimally invasive, efficacious and safe for patients with localized prostate cancer with pretreatment PSA levels less than 20 ng/ml.     

Energy-based ablative therapy of prostate cancer: high-intensity focused ultrasound and cryoablation

PURPOSE OF REVIEW: This review is an update on the role of the two minimally invasive techniques in primary therapy of organ-confined prostate cancer: as a salvage option after standard-therapy failure and for focal ablation of index tumors. RECENT FINDINGS: Energy-based ablative techniques are of growing interest for today's heterogeneous spectrum of prostate cancer. At present, primary high-intensity focused ultrasound appears to be a valid alternative to active surveillance protocols in low-risk cancers and, in older patients, to standard therapy. Morbidity is low, although postoperative impotence occurs frequently. Cryoablation has higher morbidity, even with third-generation conformal technology. With radiorecurrent cancer the potential radiation damage of the rectal wall renders transrectal high-intensity focused ultrasound more hazardous. Third-generation cryoablation seems to give better cancer control with lower morbidity in this situation. Unfortunately, long-term outcome data from controlled trials are not available. SUMMARY: These minimally invasive techniques are not magic bullets, and patients must be informed accordingly. Focal ablation of the prostate segment with the index cancer would minimize morbidity and therefore appears highly appealing. Its success depends on correct localization of the lesion. Until this is achieved with sufficient reliability by appropriate biopsy or imaging techniques it remains strictly experimental.     

Anesthetic management for high-intensity focused ultrasound (HIFU) therapy in prostate cancer patients

HIFU therapy is one of epoch-making, low-invasive treatments for prostate cancer. We investigated 71 patients who had undergone HIFU therapy from June 2004 through September 2005. We mainly gave a single spinal injection followed by epidural catheterization with a combined spinal-epidural anesthesia kit. Three patients received general anesthesia because of various problems such as allergy for local anesthetics, ankylosing spondylitis and severe spinal deformity causing difficulty in lumbar puncture. Spinal anesthesia was successfully achieved in most patients. Twelve patients with insufficient anesthetic levels required additional local anesthetics via epidural catheters. We found no serious perioperative complications.     

High-intensity focused ultrasound therapy for prostate cancer

Recent advances in high-intensity focused ultrasound, which was developed in the 1940s as a viable thermal tissue ablation approach, have increased its popularity. High-intensity focused ultrasound is currently utilized the most in Europe and Japan, but has not yet been approved by the Food and Drug Administration, USA, for this indication. The purpose of the present report is to review the scientific foundation of high-intensity focused ultrasound technology and the clinical outcomes achieved with commercially available devices. Recently published articles were reviewed to evaluate the current status of high-intensity focused ultrasound as a primary or salvage treatment option for localized prostate cancer. Improvements in the clinical outcome as a result of technical, imaging and technological advancements are described herein. A wide range of treatment options for organ-confined prostate cancer is available. However, high-intensity focused ultrasound is an attractive choice for men willing to choose less invasive options, although establishing the efficacy of high-intensity focused ultrasound requires longer follow-up periods. Technological advances, together with cultural and economic factors, have caused a dramatic shift from traditional open, radical prostatectomy to minimally invasive techniques. High-intensity focused ultrasound is likely to play a significant role in the future of oncology practice.     

Treatment of localized prostate cancer using high-intensity focused ultrasound

OBJECTIVE: To evaluate the biochemical disease-free survival (DFS), predictors of clinical outcome and morbidity of patients with localized prostate cancer treated with high-intensity focused ultrasound (HIFU), a noninvasive treatment that induces complete coagulative necrosis of a tumour at depth through the intact skin. PATIENTS AND METHODS: In all, 63 patients with stage T1c-2bN0M0 localized prostate cancer underwent HIFU using the Sonablate system (Focus Surgery, Inc., Indianapolis, IN, USA). None of the patients received neoadjuvant and/or adjuvant therapy. Biochemical recurrence was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology consensus definition, i.e. three consecutive increases in prostate-specific antigen (PSA) level after the nadir. The median (range) age, PSA level and follow-up were 71 (45-87) years, 8.5 (3.39-57.0) ng/mL and 22.0 (3-63) months, respectively. RESULTS: The overall biochemical disease-free rate was 75% (47 patients). The 3-year biochemical DFS rates for patients with a PSA level before HIFU of <10, 10.01-20 and >20 ng/mL were 82%, 62% and 20% (P < 0.001), respectively. The 3-year biochemical DFS rates for patients with a PSA nadir of <0.2, 0.21-1 and >1 ng/mL were 100%, 74% and 21% (P < 0.001), respectively. Final follow-up sextant biopsies showed that 55 (87%) of the patients were cancer-free. Multivariate analysis showed that the PSA nadir (P < 0.001) was a significant independent predictor of relapse. CONCLUSION: HIFU therapy appears to be a safe, effective and minimally invasive therapy for patients with localized prostate cancer, and the PSA nadir is a useful predictor of clinical outcome.