THE "NEW" PROSTATE CANCER INFOLINK

Investigators at Tokai University Hachioji Hospital in Tokyo have been using high-intensity, focused ultrasound (HIFU) to treat men with localized prostate cancer since January 1999. A newly-published paper provides a complete report on this experience.

According to Uchida et al., their group treated a total of 517 men with clinical stage T1c-T3N0M0 prostate cancer using Sonablate equipment between January 1999 and December 2007. Biochemical failure in these patients was defined according to the Phoenix definition (an increase in the patient’s PSA level of 2 ng/ml above the PSA nadir).

In the abstract of their paper, they summarize their results as follows (unfortunately we do not have a copy of the full paper to refer to):

• The median follow-up period for all patients was 24.0 months (range, 2 to 88 months).
• The overall rate of biochemical disease-free (BDF) survival in all patients at 5 years was 72 percent.
• The BDF survival rates in patients with clinical stage T1c, T2a, T2b, T2c, and T3 at 5 years were 74, 79, 72, 24, and 33 percent, respectively.
• The BDF survival rates in patients in the low-, intermediate-, and high-risk groups at 5 years were 84, 64, and 45 percent, respectively.
• The BDF survival rates in patients treated with or without neoadjuvant hormonal therapy at 7 years were 73 and 53 percent, respectively.
• Pre-treatment PSA levels, the use of neoadjuvant hormonal therapy, and clinical stage had a statistically significant impact on patient outcomes in multivariate analysis.
• Postoperative erectile dysfunction (ED) was noted in 33/114 patients (28.9 percent) who were potent before their treatment.

The authors conclude that, “High-intensity focused ultrasound therapy appears to be minimally invasive, efficacious and safe for patients with localized prostate cancer, particularly those with low- and intermediate-risk cancer.”

The “New” Prostate Cancer InfoLink would draw attention to the fact that the median follow-up in this patient group is actually only 2 years, so the actuarial projections reported in this study are only projections. However, even based on this actuarial analysis, the Japanese research team is clearly suggesting that: (a) the BDF survival rates in men with T2c or T3 or high-risk disease is certainly less than optimal (even with the use of neoadjuvant hormone therapy), and there was an overall incidence of post-treatment ED in about 30 percent of men classified as potent prior to treatment.

We continue to believe that HIFU will gradually become a widely accepted form of treatment for appropriate men initially diagnosed with low- and intermediate-risk prostate cancer (assuming that they actually need treatment as opposed to active surveillance). However, we also continue to believe that HIFU is likely to be a suboptimal f0rm of treatment for men with high-risk disease.