TITLE:
Enhancement of HIFU Effect by Simultaneous Short Course Degarelix for Early Stage Prostate Cancer: A Pilot Study
AUTHORS:
Teiichiro Aoyagi, Isao Kuroda
KEYWORDS:
Prostate Cancer, HIFU, Degarelix, Hormonal Therapy
JOURNAL NAME:
Open Journal of Urology,
Vol.6 No.3,
March
25,
2016
ABSTRACT: Objective: To obtain complete prostatic
cell death in the treatment of early stage prostate cancer by High Intensity
Focused Ultrasound (HIFU) therapy, we use Degarelix (GnRH antagonist) twice
simultaneously. Patients and Methods: The first Degarelix subcutaneous
injection was made two weeks before HIFU therapy, and second Degarelix was
applied two weeks after the HIFU therapy. No additional maintenance Degarelix
was used. To confirm the apoptosis induced by Degarelix, specimens obtained by
transurethral resection simultaneously on HIFU were stained with caspase 3 and
TUNEL. PSA was monitored every three months after this combination therapy as
long as two years. These PSA values were compared with those who previously
treated with HIFU without Degarelix. Results: Nine T1cN0M0 prostate cancer
patients were enrolled to “HIFU + Degarelix” therapy. Pre treatment mean PSA
level was 6.11 ± 1.83 ng/ml (SD), and PSA 3 months after the treatment was 0.02
± 0.02. These low PSA levels continued thereafter (0.16 ng/ml ± 0.19 at 24
months). The mean pretreatment PSA level of the 34 patients underwent HIFU
without Degarelix was 11.07 ± 13.9 ng/ml, 3 months post HIFU was 1.68 ± 3.04,
(2.80 ± 3.97 at 24 months). Caspase 3 and TUNEL were positive on the glandular
cells in TUR specimens of “HIFU + Degarelix” patients, suggesting Degarelix
induced apoptosis. Conclusion: Although the number of our patients was small,
the results of “Short course Degarelix + HIFU” would be promising for better
long-term outcome than HIFU mono-therapy.