Long-Term Outcomes and Prognosis of Transrectal High-Intensity Focused Ultrasound Therapy for Patients with Localized Prostate Cancer—Therapy after Recurrence and Predictive Factors

Objectives: To evaluate the outcomes and prognosis of high-intensity focused ultrasound (HIFU) therapy for patients with localized prostate cancer, and identify suitable candidates for this therapy by investigating the predictive factors. Methods: The 224 patients (low 54, intermediate 111 and high-risk patients 59) with T1-2 stage were treated using the Sonablate device and followed for over 12 months after treatment. Recurrence was determined based on histological findings, prostate-specific antigen (PSA) failure and local or distant metastasis. The factors which are predicting variables with potential effects were investigated by Kaplan-Meier and multivariate analysis. Results: A total of 255 treatment sessions (193 with one, 31 with two) were performed. No patients died of prostate cancer, but 15 died of other causes and 14 patients were lost during follow-up. The 7-year recurrence-free survival (RFS) rates in all patients were 75%, and 5-year RFS rates were 98%, 84% and 59% in the low, intermediate and high-risk patients respectively. In the 216 patients who underwent histological examination at 6 months or later after HIFU, 25 (12%) were positive. In 77 patients with recurrence after first-HIFU, the second treatments were hormonal therapy and HIFU. Of the 31 patients who underwent a second HIFU, the 5-year RFS rates were 64%, and 5-year RFS rates were 100%, 74% and 33% in the low, intermediate and high-risk patients. The significant predictor for recurrence was risk-group, T-stage (T1 vs T2), Gleason score (≤3 + 4 and ≥4 + 3), pretreatment PSA (Conclusions: Prognosis of HIFU for Patients with localized prostate cancer was good, and the low and intermediate-risk patients with T1-staging are suitable indications for HIFU. Effective predictors for outcomes were risk-group, T-stage, Gleason score, pretreatment PSA and nadir PSA.

A Comparison of Rey-Osterrieth Complex Figure Test Scores: With/Without Mouthpiece and with/without Noise

In the present study, the ROCF test was initially conducted involving 30 healthy young individuals, in a quiet environment as Experiment 1 to examine variations in the score among different methods to memorize the figure. In such an environment, no significant differences were observed in the score between the copying and outer speech groups, which suggested the possibility of some of the former groups having used outer speech in a voice too low to be heard or moving their lips without vocalization, achieving the same effect as outer speech, and consequently leading to the absence of differences from the outer speech group. On the other hand, the score markedly varied between the mouthpiece and copying or outer speech groups. As lip movements were suppressed in the former case, the unconscious use of outer speech was also prevented, possibly leading to poor results. Based on these findings, it may be possible to enhance the effects of rehabilitation in a clinical setting by promoting patients’ memorization using outer speech to vocalize the contents of training.

Utility of Tracing as a Memory Storage Method

Although many studies have explored the utility of tracing as a rehabilitation approach for patients with aphasia and alexia and for Japanese patients with various disabilities, this may be the first study to demonstrate the superiority of tracing over copying for enhancing long-term memory. We investigated the utility of tracing as a memory storage method. Young and elderly participants learned a figure from the Rey-Osterrieth complex figure test by copying or tracing its outline. They were asked to reproduce the figure after 3 min and 3 days. Although the copying group performed better than the tracing group in immediate recall after 3 min, the performance of the tracing and copying groups after 3 days was similar. Among younger participants, the tracing group achieved higher scores than the copying group after 3 days;however, the difference was not statistically significant. Copying as a learning strategy has a substantial temporal gradient of memory loss;tracing may be more appropriate for improving long-term memory. This result could have considerable practical usefulness, e.g., among professionals who provide memory training for the elderly. Tracing, which uses visuomotor memory, is acquired earlier than transcription. Tracing may be effective for rehabilitation because it is a developmentally appropriate approach to early instruction.