ParticipantsGuilherme C. Mariotti, MD, Jundiai, Brazil (Presenter) Nothing to Disclose
Paulo Kayano, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Priscila M. Falsarella, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Oliver R. Claros, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Gustavo C. Lemos, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Marcos R. Queiroz, MD, Barueri, Brazil (Abstract Co-Author) Nothing to Disclose
Rodrigo G. Garcia, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Ronaldo H. Baroni, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Arie Carneiro, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
guilherme.mariotti@einstein.br
PURPOSETo demonstrate the safety and feasibility of HIFU focal therapy (FT) in a day-clinic setting, as a primary option of treatment of Gleason 6 or 7 (ISUP 1, 2 and 3) prostate cancers (pCa) comproved by fusion MRI-transrectal ultrasound (TRUS) fusion biopsies, in a prospective study of initial 30 patients. HIFU is a non-invasive, single shot, radiation-free therapy that use real-time image guidance, directs focused beam of ultrasound waves to thermally ablate a selected portion of prostate gland.
METHOD AND MATERIALSA single-center prospective analysis of initial 37 patients with unilateral prostate cancer candidates for FT (hemi-gland or super-focal ablation) as the primary treatment option from August 2018 to March 2019. All patients were re-evaluated by MRI and fusion prostate biopsy and only patients with unilateral disease (high volume Gleason 6 or Gleason 7), prostatic volume less than 50 cc and mild lower urinary tract symptoms were included.
RESULTSThirty-seven patients were enrolled as candidates for FT based on biopsy results. Seven were excluded and underwent radical treatment due to a Gleason upgrading and 4 due to a concomitant transurethral resection of the prostate (TURP), totalizing 26 patients in our analyses. Mean prostatic volume, age, PSA and region of interest volume were: 44.7 cc, 65.1 years, 6.09 ng/dl and 0.97cm; respectively. Pre-procedure MRI showed 5.2% of patients with PIRADS 2, 15.78% with PIRADS 3, 68.42% with PIRADS 4 and 10.52% with PIRADS 5. The biopsy showed 6 patients with unilateral ISUP 1, 14 patients unilateral ISUP 2 and 6 patients with ISUP 3. Hemi-gland ablation was performed in 20 patients and super-focal ablation in 6 patients. All patients were discharged between 2 and 4 hours after the procedure. Urethral catheter was kept for 7 days. Two patients had refractory urinary retention treated with TURP. None of the patients had urinary incontinence, worsening of erectile function, bleeding, infectious complications or rectal fistulae.
CONCLUSIONIn conclusion, day clinic HIFU FT is safe and feasible as a primary option for localized and low/intermediate risk pCa, with potential clinical impact.
CLINICAL RELEVANCE/APPLICATIONHigh-intensity focused ultrasound in a day-clinic setting is a feasible technique that has the potential to provide an alternative to radical surgery or radiation-therapy with fewer complications and similar oncological outcomes in selected patients.