High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience
High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience
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DOI：
10.1016/j.urology.2003.09.020
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发表时间：
2004-02-01
期刊：
影响因子：
2.1
通讯作者：
Wieland, WF
中科院分区：
文献类型：
--
作者：
Blana, A;Walter, B;Wieland, WF
目标.报告经直肠高强度聚焦超声（HIFU）治疗局限性前列腺癌的5年结果。高强度聚焦超声（HIFU）可提供高能量，使靶区组织快速凝固坏死，而不损伤周围组织。总共有146名经活检证实的T1-T2N0M0期前列腺癌患者使用Ablatherm器械进行了治疗。所有患者的前列腺特异性抗原（PSA）水平为15 ng/mL或更低，Gleason评分为7或更低（纳入标准）。平均随访时间为22.5个月（范围4 - 62），包括PSA测量和对照六分活检。治疗后3个月的中位PSA最低值为0.07 ng/mL（范围0 - 5.67）。随访22个月后，中位PSA水平为0.15 ng/mL（范围0 - 12.11），87%的患者PSA水平恒定低于1 ng/mL;所有患者中93.4%的患者有阴性对照活检。1例有半结肠切除术和重复性肛瘘病史的患者在第二次HIFU治疗后发现1例直肠尿道瘘。所有患者中，12%的患者因梗阻接受了HIFU后经尿道切除术，但未观察到严重的压力性尿失禁（2~3级）。47.3%的患者保留了勃起功能，国际前列腺症状评分和生活质量指数从治疗前到治疗后没有变化。我们的结果证明了HIFU的有效性和低相关发病率。HIFU不排除其他治疗选择，并且是可重复的。对于不适合根治性手术的患者，HIFU似乎是一种有效的替代治疗方法。
Objectives. To report on our 5-year results with transrectal high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. HIFU delivers high energy, causing rapid coagulation necrosis of tissue within the target area without damaging the surrounding tissue.Methods. A total of 146 patients with biopsy-proven Stage T1-T2N0M0 prostate cancer have been treated using the Ablatherm device. All patients had a prostate-specific antigen (PSA) level of 15 ng/mL or less and a Gleason score of 7 or less (inclusion criteria). The mean follow-up was 22.5 months (range 4 to 62) and included PSA measurement and control sextant biopsies.Results. The median PSA nadir 3 months after treatment was 0.07 ng/mL (range 0 to 5.67). The median PSA level after a follow-up of 22 months was 0.15 ng/mL (range 0 to 12.11), and 87% of the patients had a constant PSA level of less than 1 ng/mL; 93.4% of all patients had negative control biopsies. One rectourethral fistula was noted after a second HIFU treatment in a patient with a history of hemicolectomy and repetitive anal fistulas. Of all the patients, 12% underwent transurethral resection after HIFU because of obstruction, but no severe stress incontinence (grade 2 to 3) was observed. Erectile function was preserved in 47.3% of patients, and the International Prostate Symptom Score and Quality of Life Index did not change from before to after treatment.Conclusions. Our results demonstrated the efficacy and low-associated morbidity of HIFU. HIFU does not exclude other treatment options and is repeatable. HIFU seems to be a valid alternative treatment for patients who are not suitable for radical surgery.