Original Article: Clinical Investigation
Primary whole-gland ablation for localized prostate cancer with
high-intensity focused ultrasound: The important predictors of
Po Yen Chen,
Po Hui Chiang,
Yi Yang Liu, Yao Chi Chuang and Yuan Tso Cheng
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung,
Abbreviations & Acronyms
AUC = area under curve
HIFU = high-intensity
iPSA = initial prostate-
PSA = prostate-speciﬁc
ROC = receiver operating
TURP = transurethral
resection of the prostate
Correspondence: Po Hui
Chiang M.D., Ph.D.,
Department of Urology,
Kaohsiung Chang Gung
Memorial Hospital, Chang Gung
University College of Medicine,
123 Ta-Pei Road, Niaosung,
Kaohsiung 833, Taiwan.
Received 22 June 2017;
accepted 5 March 2018.
Online publication 13 May 2018
These authors contributed
equally to this work.
Objectives: To identify predictive factors of biochemical recurrence for patients
undergoing high-intensity focused ultrasound treatment for localized prostate cancer.
Methods: We retrospectively identiﬁed patients receiving whole-gland prostate
ablation with high-intensity focused ultrasound for localized prostate cancer from 2009
to 2015. All the patients received pre-high-intensity focused ultrasound radical
transurethral resection of the prostate. We included perioperative parameters as follows:
age, preoperative prostate volume, stage of operation, initial prostate-speciﬁc antigen,
T stage, postoperative prostate-speciﬁc antigen nadir, Gleason score, time to prostate-
speciﬁc antigen nadir and the presence of prostate-speciﬁc antigen biochemical
recurrence. Multivariable Cox regression and Kaplan–Meier analysis were used for
investigating predictors of recurrence, and receiver operating characteristic analysis was
used for the cut-off values of prostate-speciﬁc antigen nadir.
Results: Among 182 patients, 26.9% had prostate-speciﬁc antigen biochemical
recurrence after high-intensity focused ultrasound during the median follow-up period of
32.21 months. Gleason score ≥7 (Gleason score 7, hazard ratio 2.877, P = 0.027), stage
≥T2b (T2b, hazard ratio 3.16, P = 0.027) and prostate-speciﬁc antigen nadir (hazard ratio
1.11, P < 0.001) were statistically signiﬁcant, whereas there was no signiﬁcance in
prostate volume and initial prostate-speciﬁc antigen. We posit that a cut-off level of
prostate-speciﬁc antigen nadir 0.43 ng/mL might be considered as an independent
predictive factor for prostate-speciﬁc antigen biochemical recurrence in high-intensity
focused ultrasound patients in multivariate analysis (P < 0.001, hazard ratio 7.39, 95%
conﬁdence interval 3.56–15.37), and created a new nadir-related prediction model for
biochemical recurrence prediction.
Conclusions: Postoperative prostate-speciﬁc antigen nadir of 0.43 ng/mL can be
considered an important predictive factor for biochemical recurrence in primary whole-
prostate gland high-intensity focused ultrasound treatment, and the nadir-related
prediction model might provide a reference for early salvage treatment. Furthermore,
Gleason score ≥7, stage ≥T2b might be associated with unfavorable outcomes, although
prostate volume and higher initial prostate-speciﬁc antigen appear not to be associated
with biochemical recurrence for the high-intensity focused ultrasound treatment.
biochemical recurrence, high-intensity focused ultrasound, prostate cancer,
prostate-speciﬁc antigen nadir.
Prostate cancer is a commonly diagnosed malignancy in elderly men with rising case num-
The great proportion of such patients are diagnosed with the status of localized dis-
Traditionally, radical prostatectomy, external beam radiotherapy and brachytherapy
treatment are the gold standard for localized prostate cancer. However, not all patient cases
are suitable for the major operation or can tolerate the toxicity of radiation. The morbidity
might have a great inﬂuence on the patients’ quality of life. Recently, minimally invasive
treatments have been developed with acceptable oncological control and limited morbidity.
HIFU was ﬁrst applied to prostate cancer in 1995,
and Uchida et al. reported the ﬁrst case
series of transrectal HIFU for prostate cancer.
The mechanism of HIFU is to emit adjustable
© 2018 The Japanese Urological Association
International Journal of Urology (2018) 25, 615--620 doi: 10.1111/iju.13581