1479 CLINICALLY SIGNIFICANT URETHRAL STRICTURE AND/OR SUBCLINICAL URETHRAL STRICTURE AFTER HIGH-INTENSITY FOCUSED ULTRASOUND PARADOXICALLY CORRELATES WITH DISEASE-FREE SURVIVAL IN LOCALIZED PROSTATE CANCER

Objectives. To assess the treatment outcomes of a single session of whole gland high intensity focused ultrasound (HIFU) for patients with localized prostate cancer (PCa).Methods. Response rates were defined using the Stuttgart and Phoenix criteria. Complications were graded according to the Clavien score.Results. At a median follow-up of 94months, 48 (44.4%) and 50 (46.3%) patients experienced biochemical recurrence for Phoenix and Stuttgart definition, respectively. The 5- and 10-year actuarial biochemical recurrence free survival rates were 57% and 40%, respectively. The 10-year overall survival rate, cancer specific survival rate, and metastasis free survival rate were 72%, 90%, and 70%, respectively. Preoperative high risk category, Gleason score, preoperative PSA, and postoperative nadir PSA were independent predictors of oncological failure. 24.5% of patients had self-resolving LUTS, 18.2% had urinary tract infection, and 18.2% had acute urinary retention. A grade 3b complication occurred in 27 patients. Pad-free continence rate was 87.9% and the erectile dysfunction rate was 30.8%.Conclusion. Single session HIFU can be alternative therapy for patients with low risk PCa. Patients with intermediate risk should be informed about the need of multiple sessions of HIFU and/or adjuvant treatments and HIFU performed very poorly in high risk patients.

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Effect of subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound on risk of urological complications in patients with localized prostate cancer

Kazan medical journal ◽

10.17816/kmj2067 ◽

2014 ◽

Vol 95 (2) ◽

pp. 216-219

Author(s):

M B Pryanichnikova ◽

R S Nizamova ◽

E S Gubanov ◽

A A Zimichev ◽

E A Boryaev

Keyword(s):

Prostate Cancer ◽

Urinary Incontinence ◽

Urethral Stricture ◽

Transurethral Resection ◽

High Intensity ◽

Focused Ultrasound ◽

High Intensity Focused Ultrasound ◽

Localized Prostate Cancer ◽

Transurethral Resection Of Prostate ◽

Urological Complications

Aim. To assess the rate and reasons for urological complications of subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound. Methods. The study included 101 patients with localized prostate cancer treated by high-intensity focused ultrasound. Two groups of patients were allocated. Patients, who did not undergo transurethral resection of prostate prior to high-intensity focused ultrasound, were included in group 1 (21 patients). Second group included patients in whom subtotal transurethral resection of prostate was performed prior to high-intensity focused ultrasound to decrease anteroposterior diameter of the prostate and urethral canal compression. The impact of treatment tactics on complications rate was defined by factor analysis. Results. Early post-surgical complications were rare, complications mostly occurred at late period. The most frequent, severe and poorly controlled complications included urinary incontinence [58 (57.8%) patients] and urethral stricture [30 (29.7%) patients]. Most of complications were registered in second group of patients compared to the first: first group - in 10 (12.5%) of cases, second group - in 77 (95.0%) of cases. Urinary incontinence was observed in 7 (33.3%) patients and urethral stricture - in 4 (19%) of patients in the first group; in 51 (63.7%) and 26 (32.5%) patients in the second group respectively; the difference was statistically significant. Conclusion. Comparative analysis of different approaches to treatment of localized prostate cancer using high-intensity focused ultrasound revealed that subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound significantly increases the risk for developing urinary incontinence and urethral strictures.

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