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High intensity focused ultrasound with Focal-One® device: Prostate-specific antigen impact and morbidity evaluation during the initial experience
Ultrasonido focalizado de alta intensidad con el dispositivo Focal-One®: impacto sobre el antígeno prostático específico y evaluación de la morbilidad durante la experiencia inicial
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"apellidos" => "Prapotnich" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 13 => array:3 [ "nombre" => "X." "apellidos" => "Cathelineau" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Urología, Institut Mutualiste Montsouris, París, France" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Radiología, Institut Mutualiste Montsouris, París, France" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Radiología, Pitié-Salpêtrière Hospital, París, France" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ultrasonido focalizado de alta intensidad con el dispositivo Focal-One<span class="elsevierStyleSup">®</span>: impacto sobre el antígeno prostático específico y evaluación de la morbilidad durante la experiencia inicial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1330 "Ancho" => 1660 "Tamanyo" => 53178 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prostate-specific antigen evolution.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Prostate cancer (PCa) treatment with high-intensity focused ultrasound (HIFU) began in the early 1990s by Dr. Albert Gelet et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> This therapy is hyperthermia based and induces a coagulative necrosis of the prostate tissue by thermal and mechanical effect and the ablative zone is demonstrable as early as 2<span class="elsevierStyleHsp" style=""></span>h after the procedure.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a> Originally, HIFU was employed for patients with low or intermediate-risk localized PCa, who were not candidates for surgery, or as a salvage treatment for patients who were previously treated with external radiotherapy (EBRT), for whom a whole gland ablation was performed.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Today, European Urology Association guidelines recommend active surveillance, radical prostatectomy, or EBRT as the standard treatment for localized PCa, depending on the tumor stage and the patient's life expectancy.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> HIFU technology has evolved over the past decade and can be a viable treatment alternative in selected patients with low/intermediate-risk PCa as a focal treatment with promising oncological and functional results, in addition to low perioperative complication rates.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5,6</span></a> Currently, there are three devices available: Ablatherm<span class="elsevierStyleSup">®</span> and Focal-One<span class="elsevierStyleSup">®</span> from EDAP-TMS (France), and Sonablate<span class="elsevierStyleSup">®</span> from SonaCare Medical (USA)<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> and Focal-One<span class="elsevierStyleSup">®</span> represent the newer generation of HIFU devices with significant technical upgrade. In this paper, we report the initial clinical experience of Focal-One<span class="elsevierStyleSup">®</span> device in the PCa treatment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods and materials</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a retrospective analysis of our prospectively collected database of patients with localized PCa, treated with Focal-One<span class="elsevierStyleSup">®</span> HIFU device between June 2014 and October 2015.</p><p id="par0020" class="elsevierStylePara elsevierViewall">With Focal-One<span class="elsevierStyleSup">®</span> we performed focal (hemiablation/sub-total) and whole-gland treatment. The clinical criteria for inclusion to perform focal treatment were: Clinical stage T1c-T2a, maximum positive biopsy: 33%, Gleason ≤7 (3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4), prostate-specific antigen (PSA) <15<span class="elsevierStyleHsp" style=""></span>ng/ml, absence of extraprostatic disease at the multiparametric magnetic resonance imaging (mpMRI), and life expectancy >10<span class="elsevierStyleHsp" style=""></span>y. Total treatment was performed for patients with a bilateral disease, or for those not candidates for surgery. Those in salvage treatment received focal or total treatment, according to an individual analysis for each case.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Cancer localization</span><p id="par0025" class="elsevierStylePara elsevierViewall">For PCa diagnosis and localization, we performed to all patients: histological diagnosis with prostate biopsy using 5<span class="elsevierStyleHsp" style=""></span>mm intervals transperineal mapping (TPMB), and image diagnosis with mpMRI. On those patients with visible lesion on, an expert radiologist performed the contouring of the prostate and the regions of interest (ROI) using a computer program, in order to be used for guidance during the procedure.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The treatment was performed under general anesthesia using the Focal-One<span class="elsevierStyleSup">®</span> device (EDAP TMS, Vaulx-en-Velin, France). Focal-One<span class="elsevierStyleSup">®</span> uses a 3<span class="elsevierStyleHsp" style=""></span>MHz transducer for the treatment combined with a 7.5<span class="elsevierStyleHsp" style=""></span>MHz image transducer. During the shooting phase, the software automatically controls the rectal position, and the cooling system maintains the rectal mucosa temperature at 14<span class="elsevierStyleHsp" style=""></span>°C. The focal point position inside the prostate was controlled in real time by the surgeon. For this procedure, the transducer was inserted into the rectum with the patient in right lateral position (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment planning was guided by ultrasound with elastic fusion of mpMRI images, localizing the ROI when it was radiologically visible. The urologist performed the prostate contour on the ultrasound image during the procedure. A safety margin was established at 4–6<span class="elsevierStyleHsp" style=""></span>mm from the sphincter to prevent damage. At the end of the HIFU, a contrast-enhanced ultrasound (CEUS) was performed with Sonovue<span class="elsevierStyleSup">®</span> to check the treated area. After treatment, a bladder catheter was placed. Patients with prostate volumes >40<span class="elsevierStyleHsp" style=""></span>cc or with symptoms of lower urinary tract (IPSS<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>8), underwent a transurethral resection of the prostate (TURP), a month before or during the same treatment.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Outcome measurement</span><p id="par0040" class="elsevierStylePara elsevierViewall">Before the treatment, patients completed these questionnaires: International Prostate Symptom Score (IPSS), International Continence Society (ICS), and International Index of Erectile Function (IIEF-5) for assessment of the baseline functional status.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Follow-up visits were conducted at 1, 3, 6, and 12 months and during each visit a physical examination, and completion of the IPSS, ICS and IIFE-5 questionnaires. Patients having no involuntary urine leak and being completely pad free, were defined as continent. The oncological follow-up included PSA measurement on each visit, and the transrectal protocol biopsy (12 core, bisextant) with a mpMRI at 1 year after treatment. Treatment failure was defined as a positive biopsy in the treated area.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The Martin–Donat criteria were followed to report the surgical complications, and severity of complications was recorded according to the Clavien classification.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">During the described period, 85 patients were treated with HIFU, using Focal-One<span class="elsevierStyleSup">®</span>. Median age was 70 years (IQR: 66–77), with a median PSA of 7.79<span class="elsevierStyleHsp" style=""></span>ng/ml (IQR: 6.32–9.16). The baseline and the treatment characteristics are summarized in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>, respectively.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The mean hospital stay was 1.8 days (range 0–7) and the mean catheterization time was 2 days (range 1–6). Perioperative complications were observed in 13 patients (15%), all Clavien 2, during the first 30 days post-treatment. At the analysis by type of treatment, the complication rate was 11% for focal treatment and 29% for whole-gland treatment. One patient had a postoperative stroke and the remaining 12 had an acute urinary retention (AUR) subsequent to the removal of the bladder catheter, requiring temporary re-insertion of catheter.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The median follow-up was 3 months (IQR: 2–8) and the average PSA decrease 54% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Nine patients had rising PSA after treatment.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Functional results: At 3 months post treatment, all patients were continent. The median pre-treatment IIEF5-5 dropped from 24 (IQR: 20–24) to 16 (IQR: 4–23) post-treatment, while the median IPSS varied from 3 (IQR: 1–5) to 4.5 (IQR: 0–8) pre- and post-treatment respectively. Sexual potency was maintained in 83% of the sexually active patients before treatment; while in the type of treatment analysis, 87% of focal treated patients, and 67% of the total treated patients maintained this function.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">We report our initial experience in the treatment of PCa with HIFU using the Focal-One<span class="elsevierStyleSup">®</span> device. This series shows an average decline in postoperative PSA values of 54% and a suitable percentage of complications.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In order to guarantee the success of this therapy, the right selection of patients to be treated with HIFU is fundamental; therefore, different factors should be considered prior to treatment.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> In our series, prostate biopsies were performed using TPMB for the identification and histological localization of the tumor. This type of approach allows for a more rigorous diagnosis, making it possible to identify more aggressive diseases with a better accuracy of the tumor size and its Gleason classification, as well as the localization of anterior lesions.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> On the other hand, the biopsy guided by image fusion is recommended by different experts<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> and it will possibly be the tool used for histological diagnosis, in the near future.</p><p id="par0085" class="elsevierStylePara elsevierViewall">It is important to consider that the maximum postero-anterior treatable distance by Focal-One<span class="elsevierStyleSup">®</span> is 40<span class="elsevierStyleHsp" style=""></span>mm; therefore, anterior lesions in prostates >40<span class="elsevierStyleHsp" style=""></span>cc could be treated improperly. Patients with obstructive lower urinary tract symptoms have an increased risk of an AUR after treatment with HIFU.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8,11</span></a> Consequently, it is necessary to perform a TURP for both cases. For the first case, a TURP must be performed 4–6 weeks before HIFU, to reduce prostate volume; and for the second case, it must be done during the same HIFU treatment, in order to avoid AUR. Different series have reported better functional and quality of life results when HIFU is associated with a TURP.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">11–13</span></a> In our population, prostates >40<span class="elsevierStyleHsp" style=""></span>g, or patients with obstructive symptoms (22 patients) underwent TURP prior to treatment with HIFU.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Currently, mpMRI is essential for imaging diagnosis of PCa.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> New technologies allow for image fusion between mpMRI and HIFU treatment in real time, admitting a live comparison of the area that is being treated and the location of the lesion.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5,7</span></a> We consider a close relationship between urologist and specialized radiologist fundamental, in order to define correctly the ROI to be treated. In our series, 50 treatments were performed using image fusion of intraoperative ultrasound and mpMRI with the previously defined ROI. It is noteworthy that the image fusion as a guide, in biopsies for diagnosis of PCa, is currently employed<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a>; however, its use for real-time treatment is still in a developing phase.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> The result of the fusion depends on a prostatic contour made on different time frames by the radiologist (preoperative mpMRI) and by the urologist (preoperative ultrasound), which may cause differences in the correlation that should be improved in the future.</p><p id="par0095" class="elsevierStylePara elsevierViewall">CEUS with sulfur hexafluoride (Sonovue<span class="elsevierStyleSup">®</span>) is used for the characterization of abdominal tumors (hepatocellular carcinoma, renal cell carcinoma, etc.), assessment of perfusion of different organs, and for the control after ablative therapies of different malignancies.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> The use of this promising tool is to distinguish between avascularized tissue and viable tissue post-HIFU<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). In our study, this radiological study was performed in 28 cases and was very useful for verification of the treated area; however, the correlation between these avascularized areas and the treatment effectiveness is yet to be proven. The objective of this procedure is to verify areas with no vascular changes that could correspond to not adequately treated areas, being possible to be re-treated in the same treatment. In the same way, CEUS can be correlated with a postoperative mpMRI, which could guide the oncological follow-up.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> The Sonovue<span class="elsevierStyleSup">®</span> is contraindicated in the recent acute coronary syndrome, unstable ischemic cardiomyopathy and other cardiovascular diseases.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">We obtained a 15% rate of perioperative complications, most frequently observed in whole-gland treatments as expected. The vast majority were AURs resolved with the placement of a bladder catheter and its subsequent withdrawal. No major complications or recto-urethral fistulas (RUF) were observed to date. These results correspond to those described in various literatures where AURs occur in up to 20% of cases, RUF <2%, and urinary tract infections in 1.8–47.9%.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> It is noteworthy that our institution was based on a wide experience using Ablatherm HIFU device allowing for a transition of technologies with a facilitated learning curve. That said, assimilating the technological paraphernalia is complex in the former cases, and the presence of urological and technological procurators was a great help to advance in our program. At the same time, the radiologist should be familiar with the contour image program.</p><p id="par0105" class="elsevierStylePara elsevierViewall">One limitation of our study is that our population is composed of different types of treatments (Hemiablation/Total and Primary/Salvage); however, we objectify a decrease of >50% in PSA values. In our series, 9 patients had rising PSA after treatment; of which 2 are free of disease, in 1 residual disease was observed and 6 are awaiting the control biopsy. Cordero Feijoo et al.,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> report that the ASTRO's criteria of biochemical recurrence and the Phoenix criteria have questionable value in focal therapy, so new strategies for biochemical follow-up with PSA should be evaluated.</p><p id="par0110" class="elsevierStylePara elsevierViewall">All our patients undergo mpMRI after a month of treatment and then after a year of treatment before the control biopsy, this test has great accuracy to determine the extent of damage that has occurred with the HIFU treatment, with the drawback that it is unable to predict histological results<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">These factors make it mandatory that patients treated with HIFU should be included in protocols with control prostate biopsy after a year of follow-up. We emphasize that HIFU treatment is non-invasive, non-ionizing, having no long-term cumulative effects, allowing for it to be repeated, considered an advantage over other ablative therapies.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Continence was not affected in any patient; however, as described in other series, there was a decline in erectile function at 3 months post-treatment.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> Despite this, >80% of previously potent patients reported erections sufficient for penetration after treatment. Noting that, in those patients who received total prostate treatment, this function was only maintained in 67% of cases.</p><p id="par0125" class="elsevierStylePara elsevierViewall">During HIFU treatment, there can be dissipation of ultrasound waves in longer focal points. The resulting prostatic edema can potentially displace the target from the firing zone during treatment. This is particularly true when ablating cancers in anterior zones, the US waves need to travel a longer distance to reach the focal point and after few initial passages, the intervening prostatic tissue undergoes edema resulting in pushing the target area further away. Another critical cancer location is the apex close to the sphincters; most of the focal therapy experience worldwide is based on thermal energies (Cryotherapy and HIFU) and these energies are found to cause some degree of sphincteric dysfunction based on the whole gland experience. HIFU is the least invasive of all the currently employed energies for the focal therapy and hence should be offered whenever feasible. PCa most commonly arises from the peripheral zone and more often below the level of the urethra.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> HIFU appears to have more advantages in this cancer location considering the shorter focal point and more precise contouring of the target area.</p><p id="par0130" class="elsevierStylePara elsevierViewall">We are faithful believers of the three pillars proposed by Linder et al.,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> for the focal treatment of PCa; <span class="elsevierStyleItalic">Planning</span>: mpMRI to identify ROI and prostate biopsies by TPMB (or perhaps fusion in the future) are essential tests to be performed for the identification and location of PCa; <span class="elsevierStyleItalic">Treatment:</span> HIFU induces coagulative necrosis, but this occurs at a focal length of 40<span class="elsevierStyleHsp" style=""></span>mm, so prostates >40<span class="elsevierStyleHsp" style=""></span>cc must be previously treated with TURP; likewise, we restrict the use of HIFU for lesions with clear anterior location, adapting the energy use to the location of the tumor within the prostate<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a>; <span class="elsevierStyleItalic">Control:</span> CEUS and post-treatment mpMRI allows for checking the area of cavitation and avascularization produced and planning possible extensions of treatment in the same surgical procedure. That said, we must understand that protocol biopsy a year after treatment is mandatory. Up to this point, the Focal-One<span class="elsevierStyleSup">®</span> is the only technology available with the possibility of applying all the pillars of focal therapy.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">HIFU treatment using Focal-One<span class="elsevierStyleSup">®</span> is a feasible and safe procedure with fewer complications. Functional results are encouraging with no reported incontinence and sexual function maintained in 83% of the patients. Further analysis should be performed to assess the oncological results of our series.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">Dr. R Sanchez-Salas – EDAP TMS consultant.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres762891" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec764367" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres762892" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec764368" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods and materials" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Cancer localization" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Treatment" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Outcome measurement" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-03-08" "fechaAceptado" => "2016-04-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec764367" "palabras" => array:4 [ 0 => "Prostate cancer" 1 => "Focal therapy" 2 => "High-intensity focused ultrasound" 3 => "Hemiablation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec764368" "palabras" => array:4 [ 0 => "Cáncer de próstata" 1 => "Terapia focal" 2 => "Ultrasonido focalizado de alta intensidad" 3 => "Hemiablación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report our initial experience in the treatment of prostate cancer (PCa) with high-intensity focused ultrasound (HIFU) using the Focal-One<span class="elsevierStyleSup">®</span> device.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective review of the prospectively populated database. Between June 2014 and October 2015, 85 patients underwent HIFU (focal/whole-gland) treatment for localized PCa. Preoperative cancer localization was done with multiparametric magnetic resonance imaging (mpMRI) and transperineal mapping biopsies. Treatment was carried out using the Focal-One<span class="elsevierStyleSup">®</span> device under general anesthesia. Oncological follow-up: PSA measurement and control biopsy with mpMRI according to protocol. Questionnaire-based functional outcome assessment was done. Complications were reported using Clavien classification.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The median PSA was 7.79<span class="elsevierStyleHsp" style=""></span>ng/ml (IQR: 6.32–9.16), with a median prostate volume of 38<span class="elsevierStyleHsp" style=""></span>cc (IQR: 33–49.75). Focal and whole-gland therapy was performed in 64 and 21 patients respectively. Ten patients received salvage HIFU. Complications were encountered in 15% of cases, all Clavien 2 graded. Mean hospital stay was 1.8 days (0–7) and bladder catheter was removed on day 2 (1–6). Mean percentage reduction of PSA was 54%. Median follow-up was 3 months (IQR: 2–8). Functional outcomes: All patients were continents at 3 months and potency was maintained in 83% of the preoperatively potent.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Focal-One<span class="elsevierStyleSup">®</span> HIFU treatment appears to be a safe procedure with few complications. Functional outcomes proved no urinary incontinence and sexual function were maintained in 83%.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Reportamos nuestra experiencia inicial en el tratamiento del cáncer de próstata (PCa) con ultrasonido focalizado de alta intensidad (HIFU) utilizando el dispositivo Focal-One<span class="elsevierStyleSup">®</span>.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de datos recogidos prospectivamente. Entre junio de 2014 y octubre de 2015, 85 pacientes recibieron tratamiento HIFU (focal/total), para PCa localizado. La localización preoperatoria del tumor fue realizada con resonancia magnética multiparamétrica (mpMRI) y biopsias prostáticas mediante mapeo transperineal. El tratamiento fue realizado utilizando el dispositivo Focal-One<span class="elsevierStyleSup">®</span> bajo anestesia general. Seguimiento oncológico: medición del PSA y biopsia control con mpMRI según protocolo. Los resultados funcionales fueron evaluados mediante cuestionarios validados y las complicaciones reportadas utilizando la clasificación Clavien.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La mediana de PSA fue 7,79<span class="elsevierStyleHsp" style=""></span>ng/ml (6,32-9,16) con una mediana de volumen prostático de 38<span class="elsevierStyleHsp" style=""></span>cc (33-49,75). El tratamiento fue focal y total en 64 y 21 pacientes respectivamente. Diez pacientes recibieron tratamiento de rescate. La tasa de complicaciones fue del 15%, todas Clavien 2. La estancia hospitalaria media fue 1,8 días (0-7) y la sonda vesical fue retirada el día 2 (1-6). La media de reducción porcentual del PSA fue 54%. La mediana de seguimiento fue 3 meses (2-8). Resultados funcionales: todos los pacientes estuvieron continentes a los 3 meses y la potencia se mantuvo en el 83% de los previamente potentes.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El tratamiento HIFU Focal-One<span class="elsevierStyleSup">®</span> es un procedimiento seguro con pocas complicaciones. Los resultados funcionales no reportan casos de incontinencia y la función sexual se mantuvo en el 83%.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Perez-Reggeti JI, Sanchez-Salas R, Sivaraman A, Linares Espinos E, de Gracia-Nieto AE, Barret E, et al. Ultrasonido focalizado de alta intensidad con el dispositivo Focal-One<span class="elsevierStyleSup">®</span>: impacto sobre el antígeno prostático específico y evaluación de la morbilidad durante la experiencia inicial. Actas Urol Esp. 2016;40:608–614.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 781 "Ancho" => 1500 "Tamanyo" => 206354 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patient positioning on Focal-One<span class="elsevierStyleSup">®</span>.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1330 "Ancho" => 1660 "Tamanyo" => 53178 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prostate-specific antigen evolution.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 722 "Ancho" => 1526 "Tamanyo" => 161326 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Contrast-enhanced ultrasound image after HIFU. (A) Image fusion and treatment planning. (B) Treated area control.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 729 "Ancho" => 1501 "Tamanyo" => 155687 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">mpMRI image 1 month after HIFU (hemiablation)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>TURP. Patient 77y, PSA: 7.5<span class="elsevierStyleHsp" style=""></span>ng/ml; PCa Gleason 3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4; mpMRI: 10<span class="elsevierStyleHsp" style=""></span>mm lesion 10p PIRADS 5/5, prostate volume 30<span class="elsevierStyleHsp" style=""></span>ml; control PSA: 1.71<span class="elsevierStyleHsp" style=""></span>ng/ml.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Data are median (IQR), number (%) or number.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">BMI, body mass index; PSA, prostate-specific antigen; mpMRI, multiparametric magnetic resonance imaging.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>85 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age, years</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (66–77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI, kg/m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (24–27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">PSA diagnosis, ng/ml</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.79 (6.32–9.16) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Prostate volume, ml</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (33–49.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Transperineal mapping</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Total cancer length, mm</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.50 (4.25–14.50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Gleason</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (61) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Tumor side</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (34) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (51) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Localization</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Base \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Apex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anterior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Multiple unilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Suspected lesion mpMRI</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (84) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">TNM</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>cT1c \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (74) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>cT2a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>cT2b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>cT2c \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">D’Amico risk group</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (51) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intermediate risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (48) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1260326.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Data are median (IQR), number (%) or number.</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">TURP, transurethral resection of the prostate; HIFU, high intensity focused ultrasound; EBRT, external beam radiotherapy; VTP, vascular targeted photodynamic therapy; CEUS, contrast-enhanced ultrasound.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>85 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pre-treatment TURP</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Type of treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Focal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Primary treatment</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (88) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Salvage treatment</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HIFU-Ablaterm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cryotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>EBRT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VTP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Treatment with image fusion</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (59) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CEUS</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (33) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1260325.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Treatment characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of prostate cancer with transrectal focused ultrasound: early clinical experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2017 October | 1 | 0 | 1 |
| 2017 June | 0 | 1 | 1 |
| 2016 December | 1 | 1 | 2 |
| 2016 November | 2 | 0 | 2 |
| 2016 September | 0 | 1 | 1 |
