IMPROVED PROSTATE CANCER OUTCOMES FROM HIFU THERAPY USING MP−MRI LOCALIZATION AND OPTIMIZED PATIENT SELECTION CRITERIA: EARLY RESULTS FROM A PILOT PROGRAM
Stephen Leslie, Omaha, NE, Ronald Wheeler*, Gerald Grubbs, Brian Wheeler, Herman Fernandez, Sarasota, FL, Aleah Bond,
INTRODUCTION AND OBJECTIVES: High Intensity Focused Ultrasound (HIFU) therapy offers significant theoretical advantages over conventional definitive treatments for localized prostate cancer with fewer side effects and reduced cost. Efficacy of HIFU, however, remains in question. The purpose of this study is to assess the outcomes of our modified HIFU patient selection protocol utilizing Multi-Parametric MRI (MP-MRI) imaging and PSA cutoff levels for the identification and improved management of localized prostate cancer patients treated with HIFU therapy.
METHODS: Retrospective 85 month pilot study of prospectively collected data on 67 HIFU patients previously identified with biopsy proven localized prostate cancer. Inclusion criteria: 1) localized lesions based on MP-MRI. 2) PSA levels ≤ 8.5 ng/ml. Outcome parameters: 1) Biochemical Disease Free Rate. 2) Need for definitive salvage therapy.
RESULTS: 67 men with biopsy proven prostate cancer (low, intermediate and high grade) and a PSA ≤ 8.5 ng/ml underwent MP-MRI imaging which confirmed localized disease. Patients were subsequently treated with definitive whole gland HIFU therapy. There were 36 patients with Gleason 6 (PSA range 0.3–8.5), 28 patients with Gleason 7 (PSA range 1.67–8.5), 2 patients with Gleason 8 (PSA range 4.6-6.3) and 1 patient with Gleason 9 (PSA of 8.1). Mean PSA prior to treatment in all groups: 5.2. Mean PSA nadir (post treatment) in all groups: 0.14 ng/ml.
Complications: Urethral narrowing or bladder neck contractures occurred in about 20% of patients but were easily treatable. No incontinence, rectal wall injury, fistulas or ED was noted long term. Mean follow-up: 27.3 months (range: 3–85 months). Biochemical Disease Free Rate was 99%. Patients needing definitive salvage therapy: 1 patient.
CONCLUSIONS: Early results of this pilot study reveal that patient selection criteria using a PSA cutoff of 8.5 ng/ml and confirmed localized disease on MP-MRI imaging, significantly improves the Biochemical Disease Free Rate and substantially reduces
the need for definitive salvage treatment following definitive HIFU therapy for prostate cancer. This data warrants further study.
Source of Funding: None