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Eur J Surg Oncol. 2018 Jan;44(1):185-191. doi: 10.1016/j.ejso.2017.11.008. Epub 2017 Dec 1.

Oncological and functional outcomes of elderly men treated with HIFU vs. minimally invasive radical prostatectomy: A propensity score analysis.

Author information

1
Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy; Institut Mutualiste Montsouris, Paris, France.
2
Institut Mutualiste Montsouris, Paris, France. Electronic address: eric.barret@imm.fr.
3
Institut Mutualiste Montsouris, Paris, France.
4
Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy.

Abstract

AIM:

To assess outcomes of whole gland high-intensity focused ultrasound (HIFU) as compared with minimally-invasive radical prostatectomy (MIRP) in elderly patients.

MATERIALS & METHODS:

Patients aged ≥70 years with, cT1-cT2 disease, biopsy Gleason score (GS) 3 + 3 or 3 + 4 and preoperative PSA ≤10 ng/mL were submitted to either whole-gland HIFU or MIRP. Propensity-score matching analysis was performed to ensure the baseline equivalence of groups. Follow-up visits were routinely performed assessing PSA and urinary function according to the International Continence Score (ICS) and the International Prostatic Symptoms Score (IPSS) questionnaires. Estimated rates of salvage-treatment free survival (SFS) overall-survival (OS), cancer-specific survival (CSS) and metastasis-free survival (MTS) were assessed and compared.

RESULTS:

Overall, 84 (33.3%) and 168 (66.7%) patients were treated with HIFU and MIRP, respectively. MIRP was associated with a 5-yrs SFS of 93.4% compared to 74.8% for HIFU (p < 0.01). The two groups did not differ in terms of OS and MTS. No cancer-related deaths were registered. Patients treated with HIFU showed better short-term (6-mos) continence outcomes [mean-ICS: 1.7 vs. 4.8; p = 0.005] but higher IPSS mean scores at 12-mos assessment. A comparable rate of patients experiencing post-treatment Clavien-Dindo grade ≥III complications was observed within the two groups.

CONCLUSIONS:

Whole-gland HIFU is a feasible treatment in elderly men with low-to intermediate-risk PCa and could be considered for patients either unfit for surgery, or willing a non-invasive treatment with a low morbidity burden, although a non-negligible risk of requiring subsequent treatment for recurrence should be expected.

KEYWORDS:

HIFU; Prostate cancer; Radical prostatectomy; Whole-gland ablation

PMID:
29223469
DOI:
10.1016/j.ejso.2017.11.008
[Indexed for MEDLINE]

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