%D 2022
%L discovery10158997
%I ELSEVIER
%P 407-413
%T Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience
%O This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
%X 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.
%V 81
%A D Reddy
%A M Peters
%A TT Shah
%A M van Son
%A MB Tanaka
%A PM Huber
%A D Lomas
%A A Rakauskas
%A S Miah
%A D Eldred-Evans
%A S Guillaumier
%A F Hosking-Jervis
%A R Engle
%A T Dudderidge
%A RG Hindley
%A A Emara
%A R Nigam
%A N McCartan
%A M Valerio
%A N Afzal
%A H Lewi
%A C Orczyk
%A C Ogden
%A I Shergill
%A R Persad
%A J Virdi
%A CM Moore
%A M Arya
%A M Winkler
%A M Emberton
%A HU Ahmed
%K Science & Technology, Life Sciences & Biomedicine, Urology & Nephrology, Focal therapy, High-intensity focussed ultrasound, Oncological outcomes, Prostate cancer, RADICAL PROSTATECTOMY, FUNCTIONAL OUTCOMES, PATIENT SELECTION, ABLATION
%N 4
%J European Urology
%C Switzerland