A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background: Clinically significant non-metastatic prostate cancer is currently treated with whole-gland therapy. These are effective but can cause urinary, sexual and rectal side-effects.
Objective: To report on 5-year prostate cancer control following focal high intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate.
Design: Prospective study of consecutive patients who underwent focal therapy using HIFU (Sonablate) (1st/January/2006-31st/December/2015).
Setting: Secondary care centres.
Participants: 625 consecutive patients with non-metastatic clinically significant prostate cancer undergoing focal HIFU, of whom 599 had minimum 6 months follow-up. 505 (84%) had intermediate or high-risk prostate cancer.
Interventions: Disease was localised using multi-parametric MRI, combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included PSA, mpMRI and biopsies.
Outcome Measurements and Statistical Analysis: The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases and cancer-specific mortality.
Results and Limitations: Median follow-up was 56 months (35-70). Median age was 65 years (IQR 61-71) and median pre-operative PSA 7.2ng/ml (IQR 5.2-10.0). FFS (95%CI) at 1, 3 and 5 years was 99% (98-100), 92% (90-95) and 88% (85-91). For low, intermediate and high-risk patients, metastasis-free, cancer-specific and overall survival at 5-years was 98% (97-99), 100% and 99% (97-100), respectively. In those patients returning validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than one pad per day. Limitation includes lack of long-term follow-up.
Conclusions: Focal therapy for select patients with clinically significant non-metastatic prostate cancer is effective in the medium term and has low probabilities of side-effects.
Patient summary: In this multicentre study of 625 patients undergoing focal therapy using high intensity focused ultrasound (HIFU), failure-free survival, metastases-free, cancer-specific and overall survival were 88%, 98%, 100% and 99%. Urinary incontinence (any pad use) was 2%. Focal therapy using HIFU to treat patients with clinically significant prostate cancer that has not spread has low probabilities of side effects and is effective at 5 years.
Objective: To report on 5-year prostate cancer control following focal high intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate.
Design: Prospective study of consecutive patients who underwent focal therapy using HIFU (Sonablate) (1st/January/2006-31st/December/2015).
Setting: Secondary care centres.
Participants: 625 consecutive patients with non-metastatic clinically significant prostate cancer undergoing focal HIFU, of whom 599 had minimum 6 months follow-up. 505 (84%) had intermediate or high-risk prostate cancer.
Interventions: Disease was localised using multi-parametric MRI, combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included PSA, mpMRI and biopsies.
Outcome Measurements and Statistical Analysis: The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases and cancer-specific mortality.
Results and Limitations: Median follow-up was 56 months (35-70). Median age was 65 years (IQR 61-71) and median pre-operative PSA 7.2ng/ml (IQR 5.2-10.0). FFS (95%CI) at 1, 3 and 5 years was 99% (98-100), 92% (90-95) and 88% (85-91). For low, intermediate and high-risk patients, metastasis-free, cancer-specific and overall survival at 5-years was 98% (97-99), 100% and 99% (97-100), respectively. In those patients returning validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than one pad per day. Limitation includes lack of long-term follow-up.
Conclusions: Focal therapy for select patients with clinically significant non-metastatic prostate cancer is effective in the medium term and has low probabilities of side-effects.
Patient summary: In this multicentre study of 625 patients undergoing focal therapy using high intensity focused ultrasound (HIFU), failure-free survival, metastases-free, cancer-specific and overall survival were 88%, 98%, 100% and 99%. Urinary incontinence (any pad use) was 2%. Focal therapy using HIFU to treat patients with clinically significant prostate cancer that has not spread has low probabilities of side effects and is effective at 5 years.
Date Issued
2018-10-01
Date Acceptance
2018-06-01
Citation
European Urology, 2018, 74 (4), pp.422-429
ISSN
0302-2838
Publisher
Elsevier
Start Page
422
End Page
429
Journal / Book Title
European Urology
Volume
74
Issue
4
Copyright Statement
© 2018 The Authors. Published by Elsevier B.V. on behalf
of European Association of Urology. This is an open access article under the CC-BY license (http://creativecommons.org/licenses/by/4.0/)
of European Association of Urology. This is an open access article under the CC-BY license (http://creativecommons.org/licenses/by/4.0/)
Sponsor
Wellcome Trust
University College London Hospitals Charity
Identifier
https://www.sciencedirect.com/science/article/pii/S0302283818304317?via%3Dihub
Grant Number
204998/Z/16/Z
1348
Subjects
Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
High-intensity focused ultrasound
Focal therapy
Transperineal biopsy
Multiparametric magnetic resonance imaging
Targeted biopsy
INTENSITY FOCUSED ULTRASOUND
RADICAL PROSTATECTOMY
ABLATION
TECHNOLOGY
INDEX
Focal therapy
High-intensity focused ultrasound
Multiparametric magnetic resonance imaging
Targeted biopsy
Transperineal biopsy
Aged
Biopsy
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Staging
Outcome Assessment, Health Care
Prospective Studies
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms
Registries
Survival Analysis
Ultrasonic Waves
Ultrasound, High-Intensity Focused, Transrectal
United Kingdom
Prostate
Humans
Prostatic Neoplasms
Prostate-Specific Antigen
Magnetic Resonance Imaging
Biopsy
Neoplasm Staging
Ultrasound, High-Intensity Focused, Transrectal
Registries
Survival Analysis
Follow-Up Studies
Prospective Studies
Aged
Middle Aged
Male
Ultrasonic Waves
United Kingdom
Outcome Assessment, Health Care
Urology & Nephrology
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2018-06-28