Transurethral Microwave Thermotherapy (TUMT) in Locally Advanced Carcinoma of the Prostate

Abstract

Objective Though systemic prostatic cancer disease eventually results in the patient's death, locally advanced disease may be associated with severe morbidity. The therapeutic options currently available include hormonal manipulation, radiotherapy or transurethral resection. Previous reports have suggested that local prostatic hyperthermia may have a dramatic effect on local and systemic malignant disease. This study aimed at evaluating the effect of transurethral microwave thermotherapy (TUMT) on locally advanced prostate cancer. Patients and Methods The study included 30 patients suffering from various degrees of bladder outlet obstruction secondary to advanced hormone-refractory prostate cancer. TUMT was delivered using the Prostalund machine (Lund Science Sweden) weekly for 6 weeks. Transurethral heating was achieved via a Foley urethral catheter provided with microwave antenna, temperature sensors and cooling channels. The rectal temperature was monitored via rectal thermosensors mounted on a specially designed rectal probe. All the patients were evaluated before and after treatment, at 1 month, at 3 months and at 1 year. Results The mean pretreatment Boyarsky symptom score was 13.73 + 4.15. At 1 month, 3 months and 1 year follow up the mean Boyarsky symptom score was 8.73 + 4.14 (P=<0.0001), 9.09+3.71 (P=<0.0001) and 8.53 + 3.98 (P=<0.0001), respectively. The mean pretreatment peak flow rate was 7.83 + 2.68 ml/sec. At 1 month, 3 months and 1 year follow up the mean peak flow rate was 10.1 + 3.17 ml/sec (P=0.0045), 10.41 + 4.35 ml/sec (P=0.011) and 7.27 + 2.79 ml/sec (P=0.513), respectively. The mean pretreatment residual urine volume was 82.5 ml + 65.4. At 3 months and 1 year follow up the mean residual urine volume was 58.2 ml + 36.5 and 54.7 ml + 51.3 (P=0.2597), respectively. The mean pre-treatment PSA value was 22 + 16.69 ng/ml. At 1 week follow up the mean PSA value was 26.9 + 18.63 ng/ml and at 1 year follow up the mean PSA value was 19+15.21 ng/ml (P=0.192). Conclusion TUMT is safe and effective in alle-viating obstructive symptoms in patients with advanced prostate cancer. The amelioration of symptoms was short-lived beginning to show a return to the pretreatment condition at the end of the 1-year follow-up period. The major advantages of TUMT are that it is an outpatient procedure, that it is well tolerated with minimal morbidity and that it can be offered safely for patients unfit for anaesthesia.

Key Words hyperthermia, cancer, prostate

Resume

La Thermothrapie Transurtrale par Micro-Ondes dans le Cancer Localement Avanc de la Prostate

Objectif Bien que le cancer de la prostate mtastasi aboutit ventuellement a la mort du patient, le cancer localement avanc peut tre associe une svre morbidit. Les options thrapeutiques actuellement disponibles incluent les manipulations hormonales, la radiothrapie ou la rsection trans-urtrale. Des tudes antrieures ont rapport que l'hypertermie locale de la prostate peut avoir un effet sur la maladie cancreuse localise ou avance. Cette tude avait pour but d'valuer les effets de la thermothrapie transurtrale par micro-ondes dans le cancer localement avanc de la prostate. Matriel et Mthodes Cette tude incluait 30 patients souffrant d'obstruction cervico-urtrale de degrs divers secondaire un cancer de la prostate avanc en chappement hormonal. La TUMT a tait ralise avec l'appareil Prostalund (Lund Science Sweden), raison d'une sance par semaine pendant 6 semaines. Le rchauffement transurtral a t obtenue travers une sonde de Foley dlivre avec une antenne micro-onde, des capteurs de temprature et un canal de refroidissement. La temprature rectale a t surveille via des capteurs thermiques rectaux monts sur une sonde rectale spciale. Tous les patients ont t valus avant le traitement, un mois, 3 mois et un an aprs la procdure. Rsultats Le score de Boyarsky moyen avant le traitement tait de 13.73+4.15. A 1 mois, 3 mois et 1 an de suivi, le score de Boyarsky moyen tait respectivement de 8.73+4.14 (p<0.0001), 9.09+3.71 (p<0.0001) et 8.53+3.98 (p<0.0001). Le dbit maximal moyen avant le traitement tait de 7.83+2.68 ml/sec. A 1 mois, 3 mois et 1 an de suivi, il tait respectivement de 10,1+3,17 ml/sec (p=0,0045), 10,41+4,35 ml/sec (p=0,011) and 7,27+2,79 ml/sec (p=0,513). Le rsidu post-mictionnel moyen avant le traitement tait de 82,5 ml+65,4. A 1 mois, 3 mois et 1 an de suivi il tait devenu respectivement 58,2 ml+36,5 and 54,7 ml+51,3 (p=0,2597). Le taux moyen de PSA avant le traitement tait de 22+16,69 ng/ml. Une semaine aprs le traitement il tait de 26,9+18,63 ng/ml et un an 19+15,21 ng/ml (p=0.192). Conclusion TUMT est sre et efficace pour soulager les symptmes obstructifs du cancer avanc de la prostate. L'amlioration des symptmes a t de courte dure revenant la situation d'avant le traitement aprs un an de suivi. Les avantages majeurs de la TUMT sont qu'il s'agit d'une procdure ambulatoire, bien tolre avec un morbidit minime qui peut tre propose des patients qui ne peuvent subir une anesthsie.


(African Journal of Urology: 2002 8 (4): 149-156)