Clinical Study

British Journal of Cancer (2009) 101, 19–26. doi:10.1038/sj.bjc.6605116 www.bjcancer.com
Published online 9 June 2009

High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series

H U Ahmed1, E Zacharakis1, T Dudderidge1, J N Armitage2, R Scott1, J Calleary1, R Illing2,3, A Kirkham3, A Freeman4, C Ogden5, C Allen3 and M Emberton1,2

  1. 1Division of Surgery and Interventional Sciences, University College London, 67 Riding House Street, London W1P 7PN, UK
  2. 2Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln Inn Fields, London, UK
  3. 3The Academic Department of Radiology, University College London Hospitals NHS Trust, 235 Euston Road, London NW1 2BU, UK
  4. 4The Department of Histopathology, University College London Hospitals NHS Trust, London, UK
  5. 5The Royal Marsden Hospital, London, UK

Correspondence: Dr HU Ahmed, E-mail: hashim.ahmed@ucl.ac.uk

Received 29 January 2009; Revised 28 April 2009; Accepted 6 May 2009; Published online 9 June 2009.

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Abstract

Background:

  

The use of minimally invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy.

Methods:

  

An analysis of men with organ-confined prostate cancer treated with transrectal whole-gland HIFU (Sonablate 500) between 1 February 2005 and 15 May 2007 was carried out in two centres. Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated.

Results:

  

A total of 172 men were treated under general anaesthetic as day-case procedures with 78% discharged a mean 5 h after treatment. Mean follow-up was 346 days (range 135–759 days). Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P=0.005). Antibiotics were given to 23.8% of patients for presumed urinary tract infection and the rate of epididymitis was 7.6%. Potency was maintained in 70% by 12 months, whereas mild stress urinary incontinence (no pads) was reported in 7.0% (12 out of 172) with a further 0.6% (1 out of 172) requiring pads. There was no rectal toxicity and no recto-urethral fistulae. In all, 78.3% achieved a PSA nadir less than or equal to0.5 mug ml-1 at 12 months, with 57.8% achieving less than or equal to0.2 mug ml-1. Then, 8 out of 13 were retreated with HIFU, one had salvage external beam radiotherapy and four chose active surveillance for small-volume low-risk disease. Overall, there was no evidence of disease (PSA <0.5 mug ml-1 or negative biopsy if nadir not achieved) after one HIFU session in 92.4% (159 out of 172) of patients.

Conclusion:

  

HIFU is a minimally invasive, day-case ablative technique that can achieve good biochemical outcomes in the short term with minimal urinary incontinence and acceptable levels of erectile dysfunction. Long-term outcome needs further evaluation and the inception of an international registry for cases treated using HIFU will significantly aid this health technology assessment.

Keywords:

HIFU, high-intensity-focused ultrasound, transrectal, prostate cancer, Sonablate500