Ablatherm HIFU for Prostate Cancer: A 10year European Experience

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Ablatherm - HIFU for Prostate CancerA 10-year
European Experience
A symposium sponsored by
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Open Questions on the Role of HIFU as a Low Side
Effects Option in the Treatment of Localized
Prostate Cancer "A medical oncologist point of
view."
U. Tirelli, Aviano (IT) National Cancer
Institute, Aviano
Ablatherm- HIFU for prostate cancer a 10-year
European experience
A symposium sponsored by
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Life Expectation in Male Population (without PCa)

• At 65 years 17 years
• At 75 years 10.5 years
• (and is rapidly increasing)

CDC, 2003
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The Prostate Cancer IncidenceCompared to Other
Tumors
Incidence(world population)
International Agency for Research on Cancer
Age
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Diagnosis of PCa in Western Countries

• More than 50 of diagnosis of PCa is made in
  patients older than 70 years
• There is a significant increase of diagnosis of
  early/local PCa in the last decades.

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To Treat or Not To Treat (elderly pts with
localized PCa) - 1 -
A study on 48.000 men with localized PCa and age
between 65 and 80 years conducted in USA based on
data of US SEER between 1991-99, showed that of
those 34.000 men who were treated with curative
approach (surgery or RT) the median survival was
significantly superior to that of those 14.500
men who were treated with only watchful waiting
approach (13 yrs vs. 10 yrs).
Yu-Ning Wong, Fox Chase Center,
Philadelphia Prostate Cancer Symposium, Feb. 2006
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To Treat or Not To Treat (elderly pts with
localized PCa) - 2 -

• However, RT and surgery were associated with
  toxic side effects.
• New local therapies should be looked for in
  this subgroup of patients.

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The Breast Cancer Model Adapted to PCa in
Early/local Disease
BREAST The quandrantectomy RT has replaced
mastectomy with obvious cosmetic /psychological
advantages and identical survival PROSTATE
CANCER HIFU could replace RT or Radical
Prostatectomy in some indications, with many
benefits in terms of Quality of life and
patients psychology and with a similar life
expectancy
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The Breast Cancer Model Adapted to PCa in Locally
Advanced Disease
BREAST The neoadjuvant therapy (hormonal CT)
allowed a lower rate of mastectomies and more
patients treated by quadrantectomies
RT PROSTATE CANCER Neoadjuvant therapy
(hormonal CT) should lead to less RT and/or
Prostatectomies and more HIFU procedures
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Randomized Studies ?

• Are the randomized studies necessary as for
  breast cancer in early and local advanced PCa
  disease ?
• Can they be performed ?
• Are they in conformity with ethics ?
• What the current clinical studies has shown
  to date ?

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Patients Who Should Be Treated by HIFU - 1 -

• Patients with confined PCa, older than 70 and
  with a life expectancy
• Patients with confined but agressive Pca, i.e.
  with a PSA 20 and Gleason 7
• Patients with locally advanced PCa who should
  take benefit of hormonotherapy HIFU
• Patients who refuses the risk of side effects of
  surgery and RT, even if younger than 60
• Young patients who refuses surgery or RT

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Patients Who Should Be Treated By HIFU - 2 -

• Patients previously treated by RT or surgery,
  with a recurrence and a measurable cancer
• Metastatic patients with a risk of obstruction
  or bleeding
• Metastatic patients but with small metastasis
  and who could be locally treated (as for
  kidney)
• Metastatic patients who due to psychologically
  reasons want to be treated locally anyway

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Why Oncology Is Coming Towards HIFU ?

• The National Cancer Institute of Aviano (IT),
  will be the first Oncologic centre in the
  world to be equipped with an HIFU device, for
  PCa treatment.
• Due to its technology and its consistent
  clinical follow-up, Ablatherm device has been
  choosen.
• Urologists will come in our CRO Institute to
  treat their patients.

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Why Oncology Is Coming Towards HIFU?

• What have been the reasons to decide to move
  towards HIFU ?
• Future non invasive gold standard primary
  treatment for non surgical patients at a
  localized PCa stage
• Probably the best salvage solution for patients
  with local recurrence after RT failure
• A promising alternative for combined medical
  treatment to be explored in the very near future
• A very safe therapeutical approach without the
  common side effects of surgery and RT

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Conclusions 1
From the medical oncologist point of view, that
often is the requested referee between surgical
and radiotherapeutical option from patients with
localized prostate cancer, HIFU seems a very
attractive (in terms of efficacy and safety)
approach for localized PCa, in particular in the
elderly patients (70 years of age).
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Conclusions 2
At our cancer institution, both surgeons and
radiotherapists are concordant for the
introduction of HIFU in the management of our
patients, both with localized and local advanced
PCa.