High-Intensity, Focused US in Localized Prostate Cancer

ATLANTA—High-intensity, focused ultrasound (HIFU) delivered through a rectal probe was highly successful at burning away localized prostate cancer, Christian Chaussy, MD, reported at the American Urological Association 2000 Annual Meeting.

Nearly 80% of the 440 men treated had negative follow-up biopsies, and more than 90% had negative biopsies after repeat HIFU. These results have been sustained over 4 years of follow-up, said Dr. Chaussy, of the Department of Urology, Staedt Krankenhaus Harlaching, Munich, Germany.

Dr. Chaussy suggested that transrectal HIFU might be a better treatment option than either watchful waiting or hormonal ablation in patients with localized prostate cancer because it is a minimally invasive, highly precise treatment method. HIFU delivers heat at a series of focal points controlled by a computer.

The patients in this study underwent transrectal HIFU under spinal anesthesia, with a mean treatment time of 96 minutes. The entire prostate was treated, and results were monitored using prostate-specific antigen (PSA) assays, sextant biopsies, and quality-of-life questionnaires. All patients were discharged from the hospital within 24 hours.

Dr. Chaussy reported that 78% of the 440 men treated had negative biopsies and that this improved to 96% with a second HIFU treatment. HIFU resulted in low PSA nadirs in all patients treated. The PSA nadir was less than 4 ng/mL in 91% of patients and less than 0.5 ng/mL in 66%.

Side effects included a high rate of urinary tract infections, some incontinence, and a rare fistula. About half the patients were potent after treatment.