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Clinical, morphological and microcirculatory criteria of local recurrence of the prostate cancer after HIFU therapy
DOI: https://dx.doi.org/10.18565/urology.2020.3.69-76
A.I. Neymark, M.A. Tachalov, B.A. Neymark, V.P. Levin
1) Department of Urology and Andrology with a course of Specialized Surgery of FGBOU VO «Altai State Medical University» of the Ministry of Health of Russia, Barnaul, Russia; 2) Department of Urology of Private Clinical Hospital «Russian Railways – Medicine», Barnaul, Russia
Aim: to study the clinical, morphological and microcirculatory criteria for treatment efficiency and prognosis of local recurrence after HIFU.
Materials and methods. On the basis of the urological department of Clinical Hospital «Russian Railways - Medicine» in Barnaul (the clinical base of the Department of Urology and Andrology with a course of Specialized Surgery of FGBOU VO «Altai State Medical University») for the period 2011–2018, a comprehensive examination and treatment of 240 patients with prostate cancer (PCa) by means of HIFU using «Ablatherm» was performed following transurethral resection of the prostate (TURP). The indication for HIFU was morphologically-proven PCa (stage T2a-cN0M0) in patients with contraindications due to comorbidities or those who refused from radical prostatectomy.
Results. A decrease in PSA to 0.5 ng/ml or less was observed in 74% of patients. A stable PSA level for 3 years was observed in 76% of patients. PSA levels differed depending on the PCa risk group. In the low-risk PCa, negative biopsy was seen in 89.6% of cases, in comparison with 72.2% and 69.4% in intermediate and high-risk PCa, respectively. There was a significant decrease in the volume of the prostate in all patients with low-risk PCa. The largest decrease in prostate volume was observed 12 months after HIFU.
Regarding recurrence-free survival after HIFU therapy, during follow-up of 3 years or more, 77% of patients didn’t have any signs of recurrence. A 3-year overall survival after HIFU was 83%.
In addition, an increase in postoperative PSA levels, change in parameters of Doppler study and laser Doppler flowmetry at the area of the prostate during the period of 6–36 months after HIFU was associated with a significant increase in the risk of recurrence of PCa at biopsy.
Conclusion. HIFU therapy is an effective treatment method for inducing prostate necrosis with minimal collateral damage to the surrounding tissue. The best results were achieved in patients with low-risk PCa. There were minimal adverse events after HIFU. In addition, in case of relapse after HIFU therapy, there is an opportunity for an early assessment of the efficiency and prognosis.
Materials and methods. On the basis of the urological department of Clinical Hospital «Russian Railways - Medicine» in Barnaul (the clinical base of the Department of Urology and Andrology with a course of Specialized Surgery of FGBOU VO «Altai State Medical University») for the period 2011–2018, a comprehensive examination and treatment of 240 patients with prostate cancer (PCa) by means of HIFU using «Ablatherm» was performed following transurethral resection of the prostate (TURP). The indication for HIFU was morphologically-proven PCa (stage T2a-cN0M0) in patients with contraindications due to comorbidities or those who refused from radical prostatectomy.
Results. A decrease in PSA to 0.5 ng/ml or less was observed in 74% of patients. A stable PSA level for 3 years was observed in 76% of patients. PSA levels differed depending on the PCa risk group. In the low-risk PCa, negative biopsy was seen in 89.6% of cases, in comparison with 72.2% and 69.4% in intermediate and high-risk PCa, respectively. There was a significant decrease in the volume of the prostate in all patients with low-risk PCa. The largest decrease in prostate volume was observed 12 months after HIFU.
Regarding recurrence-free survival after HIFU therapy, during follow-up of 3 years or more, 77% of patients didn’t have any signs of recurrence. A 3-year overall survival after HIFU was 83%.
In addition, an increase in postoperative PSA levels, change in parameters of Doppler study and laser Doppler flowmetry at the area of the prostate during the period of 6–36 months after HIFU was associated with a significant increase in the risk of recurrence of PCa at biopsy.
Conclusion. HIFU therapy is an effective treatment method for inducing prostate necrosis with minimal collateral damage to the surrounding tissue. The best results were achieved in patients with low-risk PCa. There were minimal adverse events after HIFU. In addition, in case of relapse after HIFU therapy, there is an opportunity for an early assessment of the efficiency and prognosis.
About the Autors
Corresponding author: M.A. Tachalov – Ph.D., oncourologist, Department of Urology of Private Clinical Hospital «Russian Railways – Medicine», Barnaul, Russia; e-mail: med7@mail.ru
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