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Extracts from the Journal of the French Association of Urology, the Association of Urologists of Quebec, the Belgian Society of Urology; Cancerology Committee of the French Association of Urology: 2007 guidelines in Onco-Urology

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Recommendations for HIFU for low-risk [1] and intermediate-risk [2] prostate cancer

HIFU treatment can be offered to patients (AFU charter):

– aged over 70, with a life expectancy of at least 7 years (or to younger patients when there is competing morbidity)

– with a T1-T2 N0 M0 tumour, Gleason ≤ 7 (3+4)

– a PSA value ≤ 15 ng/ml

– a prostate volume ≤ 50 cc

– a limited tumor volume (less than 4 prostate areas affected out of 6)

The treatment is applied transrecally under ultrasound guidance, after performing a transurethral resection of the prostate (synchronous or prior) to reduce the risk of postoperative urinary retention [57]. After treatment with HIFU of a low-risk cancer, the PSA nadir is less than 0.5 ng/ml in 68.4% of patients and the biopsy control is negative in 89.7%. Biological recurrence-free survival is 77% and 69% at 5 and 7 years for a median follow-up of 6.4 years. The reported complications are moderate [58]:

– 94.3% of patients are continent (5% grade 1 incontinence and 0.7% grade 2)

– 7.1% have a post-HIFU urinary tract infection

– 13.6% presented with urethral or especially prostatic obstruction.

The hindsight of the technique is insufficient to judge the long-term benefit. Patients should be made aware of this when discussing management options.

Extracts from the Journal of the French Association of Urology, the Association of Urologists of Quebec, the Belgian Society of Urology; Oncology Committee of the French Association of Urology: 2007 Recommendations in Onco-Urology pages 1174 and 1177.

Full text available on the AFU website.

Major recent publications regarding the therapeutic results of Ablatherm® HIFU

Article 1: HIFU for prostate cancer: literature review by the French Association of Urology

High-intensity focused ultrasound in prostate cancer; a systematic literature review of the French Association of Urology

Xavier Rebillard et al., BJU International 2008 1464-410X.2008.07504.x

“For the patients in the study, HIFU provides short-term cancer control as indicated by the high percentage of negative biopsies and the significant declines in PSA levels. Biochemical survival data with Ablatherm are promising. With continued improvements in Ablatherm and the practice of TURP [Trans-Urethral Resection of Prostate] prior to treatment, the rate of treatment-related complications has been reduced. The latest studies show that HIFU is very well tolerated with a better complication rate compared to recognized techniques. […]”.

Article 2: First analysis of the long-term results of transrectal HIFU in patients with localized prostate cancer. 

First Analysis of the Long-Term Results with Transrectal HIFU in Patients with Localised Prostate Cancer

Andreas Blana et al., European Urology 53 (2008) 1194-1203

“This study demonstrates that cancer is effectively controlled over the long term with HIFU for patients with low to intermediate risk prostate cancer. We believe that HIFU is a possible treatment option for patients who are not eligible for surgery. Moreover, the favorable morbidity [side effects] profile associated with this treatment should persuade physicians to offer this curative option to a greater number of patients because it is, in our opinion, an alternative to radiotherapy. »

Article 3: Recurrence of prostate cancer after radiotherapy – Salvage treatment by High Intensity Focused Ultrasound

Recurrent Prostate Cancer After Radiotherapy – Salvage Treatment by High Intensity Focused Ultrasound

  1. Murat, L.Fishmonger, A. Gelet, Edouard Herriot Hospital, Lyon, France

European Oncological Disease, Sept. 2006, 64-66

“HIFU treatment allowed local control of the tumor in 84% of patients treated for recurrence of prostate cancer after radiotherapy. Local control of the tumor is related to the initial risk factor and the Gleason score at the time of recurrence. High-risk patients (T3 or PSA >20 or Gleason score ≥8) are not good candidates for salvage HIFU treatment and should be screened strictly (18F-fluorocholine scan) as the majority have associated silent metastases to recurrence. Conversely, HIFU treatment is a very interesting curative treatment option for low and intermediate risk patients, particularly if the local recurrence Gleason score is ≤7. […] Complications after salvage HIFU treatment [after radiotherapy] are much greater than for first-line HIFU treatment. […] The morbidity [side effects] rates are quite acceptable and no cases of rectourethral fistula [formation of a hole between the rectum and urethra] have occurred with the specific treatment parameters for treatment after radiotherapy. »

[1] Low-risk prostate cancer: stage < T2b and PSA ≤10 ng/ml and biopsy Gleason score < 7.

[2] Intermediate-risk prostate cancer: prostate cancers presenting at least one of the following characteristics: PSA of 11 to 20 ng/ml or biopsy Gleason score equal to 7 or clinical stage estimated at T2b (invasive tumor a single lobe of the prostate over more than half of the lobe).

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