High Intensity Focused Ultrasound Associated With Low-dose Radiation Improve The Survival Rates Of Intermediate And Advanced Prostate Cancer Patients After Surgical Castration

PartⅠHifu associated Low Dose Raditation in Intermediate and Advanced Prostate Cancer Patients,A case control study:survival rates and morbiditiesObjectives:to observe the survival rates after high intensity focused ultrasound(HIFU) associtated with low-dose radiation in the treatment of intermediate and advanced prostate cancer and compare the severe mordity rates with conventional-dose radiation.Material and methods:We evaluated the records of 117 patients of intermediate and advanced prostate cancer in the Fudan University Zhongshan Hospital Prostate Cancer Database who had had surgical castration from 2000.3～2008.4.All patients were separated into 4 groups according the therapy,HIFU associated radiation Group (22cases),HIFU Group(23 cases),radiation Group(38cases)和control Group(single hormone therapy)(34cases).Patients of 4 groups had no significant disparity in age,initial PSA,Gleason sum and clinical stage.Statistical analysis were performed with Stata,version 7.0.to evaluate the survival rates and draw the survival curve by Kaplan-Meier method,to compare the survival curves among groups by Wilcoxon,to compare the survival rates of other 3 groups with the control group with Cox model, to compare the survival curve betweent HIFU associated with low-dose and convetional-dose radiation.To compare the survival curve between HIFU as the supplementary treatment and as salvage treatment,and to compare mordity rates among HIFU associated with low-dose radiation,HIFU associated with conventional radiation and single conventional radiation by rank-sum test.Results:①the 3-year overall suvvival rates of HIFU associate with radiation Group,HIFU Group,Radiation Group and Control Group are 100%,63.84%,73.58%and 48.56%,respectively.There had a significant disparity between HIFU associate with radition and Control Group(P=0.029),other 2 groups had no signicant disparity with Control Group.Overalsurvival curve among the 4 groups had significantdisparity (P=0.024).the 3-year disease-specific suvvival rates of HIFU associate with radiation Group,HIFU Group,Radiation Group and Control Group are 100%,63.84%, 75.74%and 54.27%,respectively.There had a significant disparity between HIFU associate with radition and Control Group(P=0.026),other 2 groups had no signicant disparity with Control Group.Disease-specific survival curve among the 4 groups had significantdisparity(P=0.014).②There had no significant disparity in overall survival rate(P=0.382) and disease-specific survival rate(P=0.677)between HIFU associate with low-dose and conventional radiation.③HIFU associate with low-dose radiation significantly decrease the sever mordity rates compared with HIFU associate with conventional radiation and single Conventional radiation(GU morbidity P=0.012,GI morbidityy P=0.011).④HIFU as supplementary therapy could significantly improve the overall survival(P=0.033) and disease-specific survival (P=0.038) rate over as salvage therapy.⑤Patients in the treatment of HIFU as supplementary therapy had a mean PSA nadir of 0.56±0.78ng/mL after mean time of 5.40±3.33 moths,and the time to nadir is shorter than single hormone therapy(control group)(P=0.036).Conclusion:HIFU associate with low-dose radiation as a supplementary treatment in the intermediate and advanced prostate cancer patients after surgical castration could significantly improve their overall survival and disease-specific survival rates,decrease the radiation related severe morbidity and then improve the survival quality.This provided a safe and effective treatment for intermediate and advanced prostate cancer. PartⅡInitial Oberservation on Body Immunity Change in the Intermediate and Advanced Prostate Cancer Patients after HIFUObjective:to investigate the anti-tumor immunity by HIFU on intermediate and advanced prostate cancer.Material and Methods:Randomly separate intermediate and advanced prostate cancer patients into 2 groups,HIFU treatment 11cases(HIFU group,all patients had the surgical castration before entrance),single surgical castration 10 cases (control group).To evaluate their CD19+ TNF-α,CD4+CD25+Foxp3+Treg Cell,VEGF, TGF-β1,IFN-γand IL-2 before and after treatment,about 4 weeks of interval. to compare the disparity by rank-sum test.Results:Patients of HIFU group had a significant decrease in TNF-α(P=0.033) and TGF-β1(P=0.046) after HIFU;patients of control group had a significant increase in CD4+CD25+Foxp3+Treg Cell;compared with difference after surgical castration in control group,difference after HIFU in HIFU group had a signicant increase in CD19~+ (P=0.005),IFN-γ(P=0.012) and IL-2(P=0.007),a significant decrease in CD4+CD25+Foxp3+Treg Cell(P=0.001),VEGF(P=0.016) and TGF-β1(P=0.027).Conclusion:Patients of intermediate and advanced prostate cancer had a immune depression after surgical castration;HIFU could effectively increase their anti-tumor immunity,by decreasing the body immune depression,secreting immune enhancing factor and increasing humoral immunity.