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Ablatherm ® - HIFU for Prostate Cancer: A 10-year European Experience. A symposium sponsored by. 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)

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Ablatherm® - HIFU for Prostate Cancer:A 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:

  • Morethan50%ofdiagnosisofPCaismadeinpatientsolderthan70years;

  • Thereisasignificantincreaseofdiagnosisofearly/localPCainthelastdecades.


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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 patient’s 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 mastectomiesand 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 < 10 years

  • 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.