Prospective comparison of five mediators of the systemic response after high-intensity focused ultrasound and targeted cryoablation for localized prostate cancer.

Abstract

To evaluate whether high-intensity focused ultrasound (HIFU) is less invasive than targeted cryoablation of the prostate (TCAP), as experimental studies suggest that the acute-phase reaction is proportional to surgery-induced tissue damage. Between May 2004 and December 2007, 127 consecutive patients undergoing HIFU (71) or TCAP (56) in our departments were assessed prospectively. Blood samples were collected 24 h before (T0), during surgery (T1), at the end of anaesthesia (T2), and at 12 (T3), 24 (T4) and 36 h after surgery (T5). The extent of the systemic response to surgery-induced tissue trauma was measured by assessing the levels of acute-phase markers tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-10, C-reactive protein (CRP) and serum amyloid A (SAA), at all sampling times in all patients. The median (interquartile range) age in the HIFU and TCAP groups was 70 (62-77) and 68 (59-75) years, respectively (P = 0.4). Baseline levels (T0) of TNF-alpha, IL-6, IL-10, CRP and SAA were comparable in both groups. The levels of all four markers increased during both procedures; the median values were higher for TCAP at T2 (P = 0.02, 0.001, <0.001 and 0.06), T3 (P < 0.001, 0.009, 0.003 and 0.001), T4 (P = 0.007, <0.001, 0.005 and <0.001) and T5 (P < 0.001, 0.004, <0.001 and 0.02), respectively. IL-6 was also higher for TCAP at T1 (P = 0.03). IL-10 did not change at the different sampling times. The tissue trauma and associated invasiveness of HIFU is less than that of TCAP, based on the variables objectively measured in this study.