eprintid: 10158997 rev_number: 10 eprint_status: archive userid: 699 dir: disk0/10/15/89/97 datestamp: 2022-11-11 16:01:50 lastmod: 2023-03-16 07:10:24 status_changed: 2022-11-11 16:01:50 type: article metadata_visibility: show sword_depositor: 699 creators_name: Reddy, D creators_name: Peters, M creators_name: Shah, TT creators_name: van Son, M creators_name: Tanaka, MB creators_name: Huber, PM creators_name: Lomas, D creators_name: Rakauskas, A creators_name: Miah, S creators_name: Eldred-Evans, D creators_name: Guillaumier, S creators_name: Hosking-Jervis, F creators_name: Engle, R creators_name: Dudderidge, T creators_name: Hindley, RG creators_name: Emara, A creators_name: Nigam, R creators_name: McCartan, N creators_name: Valerio, M creators_name: Afzal, N creators_name: Lewi, H creators_name: Orczyk, C creators_name: Ogden, C creators_name: Shergill, I creators_name: Persad, R creators_name: Virdi, J creators_name: Moore, CM creators_name: Arya, M creators_name: Winkler, M creators_name: Emberton, M creators_name: Ahmed, HU 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 ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D16 divisions: G88 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 note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. 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 ≥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. date: 2022-02-03 date_type: published publisher: ELSEVIER official_url: https://doi.org/10.1016/j.eururo.2022.01.005 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1938837 doi: 10.1016/j.eururo.2022.01.005 medium: Print-Electronic pii: S0302-2838(22)00006-9 lyricists_name: Emberton, Mark lyricists_name: Moore, Caroline lyricists_name: Orczyk, Clement lyricists_id: MEMBE52 lyricists_id: CMMOO61 lyricists_id: CORCZ53 actors_name: Emberton, Mark actors_id: MEMBE52 actors_role: owner funding_acknowledgements: [HIFU UK National Registry] full_text_status: public publication: European Urology volume: 81 number: 4 pagerange: 407-413 pages: 7 event_location: Switzerland citation: Reddy, D; Peters, M; Shah, TT; van Son, M; Tanaka, MB; Huber, PM; Lomas, D; ... Ahmed, HU; + view all <#> Reddy, D; Peters, M; Shah, TT; van Son, M; Tanaka, MB; Huber, PM; Lomas, D; Rakauskas, A; Miah, S; Eldred-Evans, D; Guillaumier, S; Hosking-Jervis, F; Engle, R; Dudderidge, T; Hindley, RG; Emara, A; Nigam, R; McCartan, N; Valerio, M; Afzal, N; Lewi, H; Orczyk, C; Ogden, C; Shergill, I; Persad, R; Virdi, J; Moore, CM; Arya, M; Winkler, M; Emberton, M; Ahmed, HU; - view fewer <#> (2022) Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience. European Urology , 81 (4) pp. 407-413. 10.1016/j.eururo.2022.01.005 <https://doi.org/10.1016/j.eururo.2022.01.005>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10158997/1/Emberton_Focal%20primary%20HIFU%20manuscript%20clean%2023.12.21.pdf