High Intensity Focused Ultrasound (HIFU) nel trattamento del carcinoma prostatico.

(High intensity focused ultrasound) HIFU is a minimally invasive treatment based on thermal ablation of tissues which are warmed up to 85°C in the focal area. From May 2002 to March 2008, 145 patients with prostate cancer, aged 44 to 86 years (mean 74.4) underwent 170 HIFU treatments. Mean PSA was 28. 1 ng/ml (range 0, 1-143) and mean Gleason sum 6.3 (range 3-9). The prognosis subgroups were defined as low-risk in 29 patients (clinical stage T1-T2a, PSA < or = 10 ng/mL, and Gleason score lower than 7), intermediate-risk in 21 patients (clinical stage T2b or PSA 10 - 20 ng/mL, or Gleason score of 7), and high-risk in 95 patients (clinical stage > or = T2c, or PSA > 20 ng/mL, or Gleason score higher than 7). At a mean follow-up of 47.1 months, biochemical success rate (PSA constantly <0.5 ng/ml) was obtained in 84.0% of low and intermediate risk patients and in 43. 1% of high risk patients; post-treatment biopsies (6 months after treatment) revealed no residual tumor in 92.8% of low or intermediate risk patients and in 62.3 % of high risk patients. Complication included: asymptomatic urinary tract infection (17.5%), pros tatitis (2.9%), epididymorchitis (1.7%), hemorrhoidal pain (0.5%), hematuria (3.5%), prostatic urethra structures (7.6%%), bladder neck sclerosis (12.3%) and rectourethral fistula (0.5%). Light stress incontinence occurred in 4.1% of the patients and erectile dysfunction in 77.8%. HIFU seems to be a promising alternative and less invasive treatment modality with an encouraging success rate, at least in the short-term. [ABSTRACT FROM AUTHOR]