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目的:探讨经直肠高强度聚焦超声(high-intensity focused ultrasound,HIFU)治疗激素难治性前列腺癌的有效性及安全性。方法:采用美国Focus Surgery公司生产的第三代HIFU Sonablate-500型治疗仪,对22例激素难治性前列腺癌患者进行治疗。根据直肠指检和经直肠前列腺B超检查前列腺肿块大小、血清PSA、ECT骨扫描等将疗效分为完全反应(CR)、部分反应(PR)、病情稳定(SD)、病情恶化(PD)。主观症状根据骨痛、排尿异常、血尿等症状的变化分为症状消失、症状改善、症状平稳、症状加剧。结果:经HIFU治疗,CR6例,占27.3%(6/22);PR11例,占50.0%(11/22);SD4例,占18.2%(4/22);PD1例,占4.5%(1/22)。总有效率(CR+PR)达到77.3%(17/22)。主观症状消失9例,占40.9%(9/22);症状改善6例,占27.3%(6/22);症状稳定3例,占13.6%(3/22);症状加剧4例,占18.2%(4/22)。主观症状总改善率(症状消失+症状改善)达到68.2%(15/22)。3例伴有血尿者均控制良好。术后并发症:3例发生附睾炎,无尿道狭窄、尿失禁、阳痿、尿道直肠瘘并发症发生。结论:HIFU对激素难治性前列腺癌的治疗有效、安全,为微创治疗激素难治性前列腺癌提供了新的途径。
Objective: To investigate the effectiveness and safety of transrectal high-intensity focused ultrasound (HIFU) in the treatment of hormone-refractory prostate cancer. Methods: Twenty-two patients with hormone-refractory prostate cancer were treated with the third-generation HIFU Sonablate-500 instrument manufactured by Focus Surgery in the United States. The curative effect was divided into complete response (CR), partial response (PR), stable condition (SD) and exacerbation of disease (PD) according to the size of the prostate mass, the PSA of the prostate and the ECT bone scan according to the digital rectal examination and transrectal B-ultrasound. Subjective symptoms According to the change of symptoms such as bone pain, urination abnormalities and hematuria, the symptoms disappear, the symptoms are improved, the symptoms are stable and the symptoms are aggravated. Results: After HIFU treatment, CR6 cases accounted for 27.3% (6/22), PR11 cases (50.0%), SD4 cases (18.2%), PD1 cases (4.5% /twenty two). The total effective rate (CR + PR) reached 77.3% (17/22). Subjective symptom disappeared in 9 cases, accounting for 40.9% (9/22); symptom improvement in 6 cases, accounting for 27.3% (6/22); stable in 3 cases, accounting for 13.6% (3/22); symptom aggravated in 4 cases, accounting for 18.2 % (4/22). The total improvement rate of subjective symptoms (symptoms disappeared + symptoms improved) reached 68.2% (15/22). 3 patients with hematuria were well controlled. Postoperative complications: 3 cases of epididymitis, no urethral stricture, urinary incontinence, impotence, complications of urethral rectal fistula occurred. Conclusion: HIFU is effective and safe for the treatment of hormone refractory prostate cancer, which provides a new way for minimally invasive treatment of hormone refractory prostate cancer.