HomeNon classéExtracts from the Journal of the French Association of Urology, the Association...

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

Publié le

spot_img

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).

Derniers articles

La psychose maniaco-dépressive : troubles bipolaires I et II

La psychose maniaco-dépressive est l’une des affections psychiatriques les plus répandues en Occident. Elle fut...

Le bâillement : mécanisme et significations

Commun à presque toutes les espèces vertébrées sur terre, le bâillement est l’un des...

La rage chez l’homme : causes, symptômes et traitements

La rage est une maladie mortelle dont la cause est le virus RABV. Ce...

HOMOCYSTEINE : facteur de risque cardio-vasculaire

L’homocystéine a fait l’objet de nombreuses spéculations depuis sa découverte en 1932. Ses propriétés...

Pour aller plus loin

La psychose maniaco-dépressive : troubles bipolaires I et II

La psychose maniaco-dépressive est l’une des affections psychiatriques les plus répandues en Occident. Elle fut...

Le bâillement : mécanisme et significations

Commun à presque toutes les espèces vertébrées sur terre, le bâillement est l’un des...

La rage chez l’homme : causes, symptômes et traitements

La rage est une maladie mortelle dont la cause est le virus RABV. Ce...