PURPOSE: To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS: Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were: PSA < 10 ng/mL, < 3 positive biopsies with only 1 lobe involved, clinical stage < T2a, Gleason score < 7 (3+4), negative CT scan and bone scan. Hemi-ablation of the prostate was performed with the Ablatherm(R) device. Survival, complication rates and urinary continence were evaluated. Control biopsies were performed at 1 year. Treatment failure was defined as a positive biopsy or need for salvage therapy. RESULTS: Twelve patients with a mean age 70 years were included. Median follow-up was 10 years. Control prostate biopsies were negative in 11/12 (91%) patients. Overall survival was 83% (10/12) and cancer specific survival was 100% at 10 years. Two patients died from other causes. Recurrence free survival was 90% (95% CI; 0.71-1) at 5 years, and 38% (95% CI; 0.04-0.73) at 10 years. Five patients had salvage therapy with repeat HIFU (n = 1) or hormonal therapy (n = 4) and all salvage patients were alive at 10 years. No patients developed lymph node or bone metastasis. No patients suffered from urinary incontinence. International Prostate Symptom Score was stable at 1 year. Complications included two urinary tract infections and one episode of acute urinary retention. CONCLUSIONS: Hemi-prostate ablation with HIFU can be safely performed in selected elderly patients with adequate long-term cancer control and low complication rates. Results from larger prospective studies using improved imaging techniques and extensive biopsy protocols are awaited.

Objectives: To review the literature and present a contemporary image of androgen deprivation for prostate cancer. Methods: We conducted a PubMed search on intermittent androgen deprivation. Articles obtained on intermittent androgen deprivation (IAD) and the experiences at Institut Montsouris were used for the review. Results: IAD is an approach to hormonal deprivation that holds effective cancer control while preventing the morbidity associated with continuous androgen blockade. IAD nuances have been assessed by urological community teams in order to verify its possible potential benefits. Evidence based approach supports the idea of IAD as a standard of therapy for advanced prostate cancer requiring hormone deprivation. Variation among medical teams' criteria for the treatment and surveillance await standardization. Conclusions: Reassessing the gold standard of hormonal blockade in advanced prostate cancer is mandatory. The undeniable evolution of IAD needs to be embraced by the urological community.

Objetivo: Revisar la bibliografía y presenter una visión contemporánea del bloqueo androgénico en el cáncer de próstata. Métodos: llevamos a cabo una búsqueda bibliográfica en PubMed sobre bloqueo androgénico intermitente (BAI). Para la elaboración del presente artículo utilizamos los artículos obtenidos y la experiencia del Instituto Mutualista Montsouris. Resultados: El BAI es un abordaje del tratamiento de deprivación androgénica que mantiene un control oncológico eficaz y a la vez evita la morbilidad asociada con el bloqueo androgénico continuo. Los matices del BAI han sido evaluados por la comunidad urológica para verificar sus posibles beneficios. Un abordaje basado en la evidencia apoya la idea del BAI como un tratamiento estándar en cáncer de próstata avanzado que necesite bloqueo androgénico. Las variaciones entre los equipos médicos en los criterios de tratamiento y vigilancia están a la espera de estandarización. Conclusiones: Es necesario revisar el "Gold Standard" del bloqueo androgénico en cáncer de próstata avanzado. La evolución innegable del BAI necesita que la comunidad urológica lo abrace.