1. No category

R. van Velthoven, MD, PHD
K. Limani, MD
JULES BORDET INSTITUTE
BRUSSELS
HIFU Symposium
HIFU SYMPOSIUM
« zonal » HIFU : a single
institution experience
HIFU for Localized PCa
 For whom is it ?
CCAFU guidelines
•Patients over 70 years,
•with at least 7 years life expectancy
(or younger with significant comorbidities )
•T1-T2N0M0
•Gleason≤7 (3+4)
•PSA ≤15ng/ml
•Volume ≤50cc
•Limited tumor Volume (less < 4/6 prostatic areas)
?? Focal Therapy ??
 Pathology on 1184 RPr specimens
 1/5 men have small volume
and completely unilateral
cancers
 The laterality of PrCa is a rationale
of local ablative therapy
Mouraviev et al., Cancer 2007
Where is the (target) tumor??
 Tumor localization:
 SPECTRO MRI 3 tesla
Courtesy Pr. S. Joniau
Pca Localized  Hifu « Focalized »
Early enhancement on GAD phase
 Strictly unilateral + BX
 Complete Concordance
with MRI ( ≥ 1,5 T)
T1W axial MRI, 1min
post gadolinium contrast
Pca Localized  Hifu « Focalized »
MRI images
Ready for fusion
3D echography
Biopsies labelling
Pca Localized  Hifu « Focalized »
FILE
AGE
DATETT
105177
76
14-févr-2007
32 zonal treatments
1303925
69
1-avr-2007
1-août-2007
Median age:1306649 70,2 69
yrs
1306831
72
1-oct-2007
PSA before tt:
5,36
ng/ml
1307736
71
1-nov-2007
1310739
69
2-févr-2008
Median Gleason : 6.3
1309628
70
15-févr-2008
Median follow
up:
1.2
yrs
1303090
76
1-avr-2008
1313968
65
10-août-2008
1314294
80
1-oct-2008
1315770
55
1-oct-2008
1316776
73
9-déc-2008
125280
83
11-déc-2008
1315689
63 < 415-janv-2009
PSA
132038
63
22-janv-2009
1318211
72
14-avr-2009
4
10
1318795
72
19-mai-2009
1318211
72
13-août-2009
139758
29-sept-2009
>7510 ng/ml
164769
71
13-oct-2009
89484
70
29-oct-2009
Total
nb
168296
71
29-oct-2009
1318462
62
3-déc-2009
1322342
66
14-janv-2010
MO FUP
NAHT
PSA PRETT
GLEASON
SIDE
36
34
30
28
27
24
24
22
18
16
16
14
14
13
13
10
9
6
5
4
4
4
2
1
0
0
0
0
0
0
3 MO
6 MO
3 MO
0
0
0
0
0
0
0
0
0
0
0
0
9
0
0
0
6,4
7,6
4,1
7
2,1
6,9
0,9
0,3
0,7
6,9
3,8
10,95
6,57
10,26
1,85
6,55
4,74
8,79
4,46
5,53
1,23
1,74
5,03
5,7
3+3
3+3
3+3
3+4
2+3
4+4
3+2
4+3
4+5
3+4
3+4
3+3
3+4
3+3
3+3
3+3
3+3
3+3
3+4
3+3
3+3
3+3
3+3
2+2
D
D
G
D
D
D
D
D
D
G
D
D
G
D
G
D
D
D
G
G
G
D
D
G
Gleason
≤6
5
12
4
21
Gleason
=7
4
5
Gleason
>7
1
1
2
NB
10
18
4
32
Pca Localized  Hifu « Focalized »
Patient
SIDE
LENGTH
VOLUME
VOLUTT
PERCENT
CATH
HOSPIT
105177
D
96
37,7
28,3
75,066313
2
2
1303925
D
90
29,3
21,8
74,40273038
2
3
1306649
G
70
23
11,5
50
3
3
1306831
D
85
28,4
16
56,33802817
2
5
1307736
D
75
21,2
11
51,88679245
2
3
1310739
D
75
20,5
15,7
76,58536585
2
4
1309628
D
79
15
9
60
2
4
1303090
D
80
28
17
60,71428571
2
5
9,5
63,33333333
2
4
15,7
54,32525952
2
4
16,8
72,79029463
2
4
19,6
39,16083916
2
4
19,9
62,97468354
2
4
15,07
63,8559322
2
6
21,9
48,23788546
2
4
Median hifu time:
1313968
D
Median volume
meas:
1314294
G
1315770
Median volume
treated: D
1316776
D
Percentage treated
125280
G
1315689
D
Catheter time
132038
G
Hospital stay1318211
D
74,83
70
28,4 51
16,2 89
66
58,4 74
3 72
4 61
67
min
15
cc 28,9
cc 23,08
50,05
% 31,6
d 23,6
d 45,4
18,1
13,3
73,48066298
2
5
1318795
D
161
29,3
22
75,08532423
2
4
1318211
D
48
18,1
11
60,77348066
2
5
139758
G
51
19,3
11,2
58,03108808
2
4
164769
G
68
44,3
18,6
41,98645598
2
4
89484
G
97
26,6
15,9
59,77443609
2
4
168296
D
56
11,5
6
52,17391304
2
4
1318462
D
61
32,1
18
56,07476636
2
4
1322342
G
54
32,2
16,19
50,27950311
2
5
Pca Localized  Hifu « Focalized »
 Median 3 month PSA nadir:
0,92 ng/ml
 Phoenix criteria (nadir +2):
4 patients
Contralateral Pca in 2/4
 Pca progression within 6 months:
2 understaged patients
Pca Localized  Hifu « Focalized »
Biochemical(1) failure free survival rate, % (at risk)
 1-year
 2-year
 3-year
(1)
Phoenix definition (nadir+2 ng/mL)
90 (20)
67 (15)
40 (6)
Pca Localized  Hifu « Focalized »
 Incontinence
 Urinary infection
 Bladder outlet obstruction
 Hematuria
 Potency
 Other micturition problems
3 grade 1 (1 pre-existing)
5 UTI, 1 prostatitis
6 (2 due to stenosis and 1 due
to tissue sloughing)
5
3*
7**
*Out of 7 patients with no Erectile Dysfunction (ED) before HIFU,
3 became impotent and 2 developed moderate ED
** Urgency (2), urge incontinence (1), pollakyuria (1), dysuria (3)
HIFU for Localized Pca:
Conclusions
 For low and intermediate risk patients, local control of the
disease is a valid alternative instead of:
 Wawa or heavy treatment
 With good oncological outcome and reduced morbidity
 As patients are followed with serial PSA, relapsing ones will
undergo biopsy and if needed re-HIFU treatment
 Probably with the improvement of imaging modalities (like
image fusion), HIFU will have more promising results