限局性前立腺癌における経尿道的前立腺切除術(TURP)併用高密度焦点式超音波(HIFU)療法 : 尿道カテーテル早期抜去の試み

Abstract

尿道カテーテル早期抜去と術後の排尿障害の軽減を目的としてHIFU療法直後の18例にTURPを併用し(併用群, 平均年齢65.6歳), HIFU単独治療の18例(単独群, 平均年齢69.3歳)と治療成績を比較した。術後尿道カテーテル期間の中央値は併用群では5日であり, 単独群の13日と比較して有意な短縮を認めた。国際前立腺症状スコアは術後1ヵ月および3ヵ月において併用群で有意な改善を認めた。重症尿道狭窄は併用群1例, 単独群2例であった。完全寛解率は両群で明らかな差を認めなかったが, 前立腺特異抗原(PSA)の最低値および6ヵ月後のPSA値は併用群が低値を示した。TURPの併用によりHIFU療法の術後排尿障害の合併率を低下させる可能性が示唆された。

We studied the impact of combined transurethral resection of the prostate (TURP) and high intensity focused ultrasound (HIFU) for localized prostate cancer (CaP) to decrease side effects such as prolonged urinary voiding disturbance observed after HIFU treatment. Included in this study were 18 patients with clinically localized CaP indicated for HIFU just followed by TURP (TUR combination group). Complete response was defined in accordance with ASTRO consensus statement and negative sample in biopsies performed 6 months after the HIFU treatment. Prostate specific antigen (PSA) nadir, International Prostate Symptom Score (IPSS) and morbidity during follow-up of TUR combination group were compared with those of a control of 18 patients who took HIFU treatment alone (HIFU monotherapy group). No statistical significances on the values of preoperative parameters (PSA, prostate volume, Gleason score, and IPSS) between these two groups. The median follow-up duration was 10 (5-15) months in both groups. A statistically significant impact was observed between TUR combination group and HIFU monotherapy group on median catheter time (5 versus 13 days, P<0.0001), PSA nadir (0.096 ng/ml versus 0.430 ng/ml in median, P<0.05) and the evolution of the post-treatment IPSS (8 versus 13.5 in median, P<0.0003) at 3 months after treatment. Urethral stricture necessary for urethral dilation was noted in 1 patient (5.6%) in the TUR combination group while in 2 (11.1%) in the HIFU monotherapy group. CR was obtained in 88.9% in the TUR combination group and 83.3% in the HIFU monotherapy group. Our study suggests that the combination of TURP with HIFU treatment improves posttreatment urinary status without additional morbidity.