TY  - JOUR
PB  - ELSEVIER
A1  - Reddy, D
A1  - Peters, M
A1  - Shah, TT
A1  - van Son, M
A1  - Tanaka, MB
A1  - Huber, PM
A1  - Lomas, D
A1  - Rakauskas, A
A1  - Miah, S
A1  - Eldred-Evans, D
A1  - Guillaumier, S
A1  - Hosking-Jervis, F
A1  - Engle, R
A1  - Dudderidge, T
A1  - Hindley, RG
A1  - Emara, A
A1  - Nigam, R
A1  - McCartan, N
A1  - Valerio, M
A1  - Afzal, N
A1  - Lewi, H
A1  - Orczyk, C
A1  - Ogden, C
A1  - Shergill, I
A1  - Persad, R
A1  - Virdi, J
A1  - Moore, CM
A1  - Arya, M
A1  - Winkler, M
A1  - Emberton, M
A1  - Ahmed, HU
Y1  - 2022/02/03/
IS  - 4
KW  - Science & Technology
KW  -  Life Sciences & Biomedicine
KW  -  Urology & Nephrology
KW  -  Focal therapy
KW  -  High-intensity focussed ultrasound
KW  -  Oncological outcomes
KW  -  Prostate cancer
KW  -  RADICAL PROSTATECTOMY
KW  -  FUNCTIONAL OUTCOMES
KW  -  PATIENT SELECTION
KW  -  ABLATION
TI  - Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience
SP  - 407
UR  - https://doi.org/10.1016/j.eururo.2022.01.005
VL  - 81
N2  - 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 ?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 ?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 >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.
AV  - public
EP  - 413
JF  - European Urology
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
ID  - discovery10158997
ER  -