Il dott. Comeri presenta la terapia focale, una nuova frontiera nel trattamento del carcinoma alla prostata

1. 1° CONVEGNO SIURO LOMBARDIA Il Carcinoma della prostata nel terzo millennio Centro Convegni LE ROBINIE Solbiate Olona (Va) 25 ottobre 2008

3. American Cancer Society , Cancer Facts & Figures 2005 Relative Survival Rates Survival in relation to men who do not have prostate cancer 1995-2005 stage at diagnosis 90% localized 5% distant

8. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. 7% 10% 17% 24% 27% 1% 1% 2% 5% 7% 0 5 10 15 20 25 30 ? 0-0.5 0.6-1.0 1.1-2.0 2.1-3.0 3.1-4.0 PSA Level (ng/ml) % of Men with Prostate Cancer and High- Grade Disease Percent with Prostate Cancer Percent with Gleason > 7 Disease Thompson IM, et al. N Engl J Med. 2004 May 27;350(22):2239-46 . (13%) (10%) (12%) (19%) (25%) Relationship of the PSA Level to the Prevalence of Prostate Cancer and High-Grade Disease

11. The PCA3 Score in low volume /low grade PCa is significantly lower than in significant PCa Low volume: tumour volume < 0.5 mL; Low grade: Gleason Score  6 Nakanishi H, et al. ASCO 2007 Prostate Cancer Symposium: abs. 354

17. Ahmed HU et al. (2007) Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract Oncol 4 : 632 –642 doi:10.1038/ncponc0959 Figure 1 Radical prostatectomy step sections.

23. Ahmed HU et al. (2007) Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract Oncol 4 : 632 –642 doi:10.1038/ncponc0959 Figure 2 Template mapping biopsies demonstrating 4 cores positive for adenocarcinoma out of a total of 30 cores.

29. TERMOABLAZIONE PROSTATICA CON RF

31. RITA dispositivo con infusione di salina

36. TERMOABLAZIONE DEL CARCINOMA PROSTATICO CON HIFU

37. 0 20 40 60 80 100 Radical Prostatectomy Beam RT HIFU Comparison HIFU 5-year biochemical survival with the range published for low-risk prostate cancer since 2000 Biochemical Disease Free Rate (%) 82% 1 94% 4 84% 5 1. Blana et al European Urology, In press, 2007 2. De Meerleer et al Radiother Oncol. 2007;82(2):160-6. 3. Goldner et al Strahlenther Onkol. 2006;182(9):537-42. 4. Stokes et al Int J Radiat Oncol Biol Phys. 2000;47(1):129-36. 5. Ciezki et al Int J Radiat Oncol Biol Phys. 2004;60(5):1347-50. 100% 2 55% 3

38. 0 20 40 60 80 100 Radical Prostatectomy Beam RT HIFU Comparison HIFU 5-year biochemical survival with the range published for moderate-risk prostate cancer since 2000 Biochemical Disease Free Rate (%) 75% 1 87% 4 72% 5 1. Blana et al European Urology, In press, 2007 2. De Meerleer et al Radiother Oncol. 2007;82(2):160-6. 3. Goldner et al Strahlenther Onkol. 2006;182(9):537-42. 4. Stokes et al Int J Radiat Oncol Biol Phys. 2000;47(1):129-36. 5. Ciezki et al Int J Radiat Oncol Biol Phys. 2004;60(5):1347-50. 94% 2 40% 3

39. 0 10 20 30 40 50 Radical Prostatectomy ‡ HIFU † Beam RT ‡ 7% 1 2.3% 2 49% 5 5% 6 15% 3 0% 4 Occurrence (%) † excluding grade I, ‡ pad rate. 1. Ficarra et al, BJU Int. 2006 Dec;98(6):1193-8. 2. Chaussy and Thuroff Curr Urol Rep. 2003;4(3):248-52. 3. Zelefsky et al, Int J Radiat Oncol Biol Phys. 2002 Aug 1;53(5):1111-6; 4. Brabbins et al, Int J Radiat Oncol Biol Phys. 2005 Feb 1;61(2):400-8. 5. Steineck et al, N Engl J Med. 2002 Sep 12;347(11):790-6; 6. Abou-Elela et al, Eur J Surg Oncol. 2007; 33:96-101 Incontinence (range published in the literature since 2000)

40. Impotence (range published in the literature since 2000) 0 20 40 60 80 100 Radical Prostatectomy HIFU Beam RT 91% 5 14% 6 63% 3 41% 4 1. Blana et al Urology. 2004 Feb;63(2):297-300. 2. Thuroff et al. J Endourol. 2003 Oct;17(8):673-7. 3. Potosky et al, J Natl Cancer Inst. 2000 Oct 4;92(19):1582-92; 4. Matalinska et al, J Clin Oncol. 2001 Mar 15;19(6):1619-28; 5. Matalinska et al, J Clin Oncol. 2001 Mar 15;19(6):1619-28; 6. Walsh et al, J Urol. 2000 Jun;163(6):1802-7. Occurrence (%) 13% 2 53% 1

41. Rectal Injury (range published in the literature since 2000) 1. Gelet et al J Endourol. 2000 Aug;14(6):519-28; 7. Poissonnier et al Prog Urol. 2003;13(1):60-72; 3. Chrouser et al J Urol. 2005 Jun;173(6):1953-7. 4. Gillitzer et al J Urol. 2004 Jul;172(1):124-8. 5. Shrader-Bogen et al. Cancer. 1997 May 15;79(10):1977-86. 6. Lim et al J Urol. 1995 Oct;154(4):1420-5. 0 1 2 3 4 5 Radical Prostatectomy HIFU (pre 2003) Beam RT Occurrence (%) ≤ 1.0 % 1 0 10 20 30 40 50 Radical Prostatectomy HIFU Beam RT 19% 6 0% 43% 5 0% Occurrence (%) NONE REPORTED Severe (fistula – requiring intervention) Moderate (bleeding, urgency, diarrhea) ≤ 0.6 % 3 ≤ 1.1 % 4 0% ≤ 0.5 % 2 HIFU (post 2003)