Mp18-14 a Multi-Institutional Prospective Study of Focal Therapy With Histotripsy Using High-Intensity Focused Ultrasound for Patients With Localized Prostate Cancer in Japan

You have accessJournal of UrologyImaging/Uroradiology I (MP18)1 May 2024MP18-14 A MULTI-INSTITUTIONAL PROSPECTIVE STUDY OF FOCAL THERAPY WITH HISTOTRIPSY USING HIGH-INTENSITY FOCUSED ULTRASOUND FOR PATIENTS WITH LOCALIZED PROSTATE CANCER IN JAPAN Sunao Shoji, Jun Naruse, Daichi Nishikawa, Moeko Tazawa, Tatsuo Kano, Satoshi Kuroda, Tatsuya Umemoto, Nobuyuki Nakajima, Masahiro Nitta, Masanori Hasegawa, Yoshiaki Kawamura, and Akira Miyajima Sunao ShojiSunao Shoji , Jun NaruseJun Naruse , Daichi NishikawaDaichi Nishikawa , Moeko TazawaMoeko Tazawa , Tatsuo KanoTatsuo Kano , Satoshi KurodaSatoshi Kuroda , Tatsuya UmemotoTatsuya Umemoto , Nobuyuki NakajimaNobuyuki Nakajima , Masahiro NittaMasahiro Nitta , Masanori HasegawaMasanori Hasegawa , Yoshiaki KawamuraYoshiaki Kawamura , and Akira MiyajimaAkira Miyajima View All Author Informationhttps://doi.org/10.1097/01.JU.0001008672.83391.ed.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the targeting accuracy and clinical outcomes of focal therapy with histotripsy, using high-intensity focused ultrasound (HIFU), for patients with localized prostate cancer (PC). METHODS: We prospectively enrolled patients with localized PC exhibiting prostate specific antigen (PSA) levels≤20 ng/mL. Clinically significant PC (csPC) was detected using magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion image-guided target biopsy and systematic biopsy. Focal histotripsy with HIFU was administered to MRI-visible PC lesions. Intra-operatively, energy output was adjusted until hyper-echoic changes became visible across the entire therapeutic area on TRUS, surpassing conventional energy levels and indicating histotripsy. This was a multi-institution study. RESULTS: We enrolled 240 patients with a median age of 69 years old and a median PSA level of 6.42 ng/mL. Patients were classified by D'Amico risk as follows: low (n=51), intermediate (n=107), and high (n=82). In all patients, blood flow disappeared from the treated area, while blood flow remained just outside the treated area on dynamic contrast-enhanced MRI. The 7- and 5-year biochemical disease-free survivals (Phoenix ASTRO definition) after a single treatment for the low-, intermediate-, and high-risk groups were 89.6%, 88.5%, and 81.6%, and 93.7%, 88.5%, and 84.8%, respectively. CsPC detection rates during follow-up were 7.8%, 8.4%, and 13.4%, in the low-, intermediate-, and high-risk groups, respectively. CsPC was detected outside the treated area in these cases. The Expanded Prostate Cancer Index Composite (EPIC) scores over 24 months revealed that urinary function, urinary bother, urinary irritative/obstructive, and sexual function 1 month after treatment had deteriorated significantly but returned to preoperative levels at 3 or 6 months after treatment. Urinary incontinence, bowel function, bowel bother, sexual bother, hormonal function, and hormonal bother remained unchanged. In terms of complications (CTCAE v.5.0), the rates of urethral strictures (Grade 2), urinary incontinence (Grade 1), and recto-urethral fistula were 2.9%, 1.3%, and 0%, respectively. The rate of erectile dysfunction among patients with functional erections was 24% at 12 months after treatment. CONCLUSIONS: Focal therapy with histotripsy using HIFU demonstrates accuracy as a pre-procedural plan and holds the potential to improve medium-term oncological outcomes without the risk of functional deterioration. Source of Funding: none © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e306 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sunao Shoji More articles by this author Jun Naruse More articles by this author Daichi Nishikawa More articles by this author Moeko Tazawa More articles by this author Tatsuo Kano More articles by this author Satoshi Kuroda More articles by this author Tatsuya Umemoto More articles by this author Nobuyuki Nakajima More articles by this author Masahiro Nitta More articles by this author Masanori Hasegawa More articles by this author Yoshiaki Kawamura More articles by this author Akira Miyajima More articles by this author Expand All Advertisement PDF downloadLoading ...