@article{discovery10158997,
           month = {February},
            year = {2022},
          number = {4},
           pages = {407--413},
           title = {Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience},
       publisher = {ELSEVIER},
          volume = {81},
            note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.},
         journal = {European Urology},
        keywords = {Science \& Technology, Life Sciences \& Biomedicine, Urology \& Nephrology, Focal therapy, High-intensity focussed ultrasound, Oncological outcomes, Prostate cancer, RADICAL PROSTATECTOMY, FUNCTIONAL OUTCOMES, PATIENT SELECTION, ABLATION},
        abstract = {Background: Focal therapy aims to treat areas of cancer to confer oncological control whilst reducing treatment-related functional detriment. Objective: To report oncological outcomes and adverse events following focal high-intensity focused ultrasound (HIFU) for treating nonmetastatic prostate cancer. Design, setting, and participants: An analysis of 1379 patients with {$\ge$}6 mo of follow-up prospectively recorded in the HIFU Evaluation and Assessment of Treatment (HEAT) registry from 13 UK centres (2005-2020) was conducted. Five or more years of follow-up was available for 325 (24\%) patients. Focal HIFU therapy used a transrectal ultrasound-guided device (Sonablate; Sonacare Inc., Charlotte, NC, USA). Outcome measurements and statistical analysis: Failure-free survival (FFS) was primarily defined as avoidance of no evidence of disease to require salvage whole-gland or systemic treatment, or metastases or prostate cancer-specific mortality. Differences in FFS between D'Amico risk groups were determined using a log-rank analysis. Adverse events were reported using Clavien-Dindo classification. Results and limitations: The median (interquartile range) age was 66 (60-71) yr and prostate-specific antigen was 6.9 (4.9-9.4) ng/ml with D'Amico intermediate risk in 65\% (896/1379) and high risk in 28\% (386/1379). The overall median follow-up was 32 (17-58) mo; for those with {$\ge$}5 yr of follow-up, it was 82 (72-94). A total of 252 patients had repeat focal treatment due to residual or recurrent cancer; overall 92 patients required salvage whole-gland treatment. Kaplan-Meier 7-yr FFS was 69\% (64-74\%). Seven-year FFS in intermediate- and high-risk cancers was 68\% (95\% confidence interval [CI] 62-75\%) and 65\% (95\% CI 56-74\%; p = 0.3). Clavien-Dindo {\ensuremath{>}}2 adverse events occurred in 0.5\% (7/1379). The median 10-yr follow-up is lacking. Conclusions: Focal HIFU in carefully selected patients with clinically significant prostate cancer, with six and three of ten patients having, respectively, intermediate- and high-risk cancer, has good cancer control in the medium term. Patient summary: Focal high-intensity focused ultrasound treatment to areas of prostate with cancer can provide an alternative to treating the whole prostate. This treatment modality has good medium-term cancer control over 7 yr, although 10-yr data are not yet available.},
          author = {Reddy, D and Peters, M and Shah, TT and van Son, M and Tanaka, MB and Huber, PM and Lomas, D and Rakauskas, A and Miah, S and Eldred-Evans, D and Guillaumier, S and Hosking-Jervis, F and Engle, R and Dudderidge, T and Hindley, RG and Emara, A and Nigam, R and McCartan, N and Valerio, M and Afzal, N and Lewi, H and Orczyk, C and Ogden, C and Shergill, I and Persad, R and Virdi, J and Moore, CM and Arya, M and Winkler, M and Emberton, M and Ahmed, HU},
             url = {https://doi.org/10.1016/j.eururo.2022.01.005}
}