Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer

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Title: Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer
Authors: Kanthabalan, A
Peters, M
Van Vulpen, M
McCartan, N
Hindley, RG
Emara, A
Moore, CM
Arya, M
Emberton, M
Ahmed, HU
Item Type: Journal Article
Abstract: Objective To assess short- to medium-term cancer control rates and side effects of focal salvage high- intensity focused ultrasound (HIFU). Materials and Methods A retrospective registry analysis identified 150 men who underwent focal salvage HIFU (FS-HIFU) (Sonablate 500) between November 2006 and August 2015. Metastatic disease was excluded by nodal assessment on the pelvic MRI, a radioisotope bone scan and positron-emission tomography (PET) imaging (choline-18F-fluorodeoxyglucose PET or choline PET-CT). In our current clinical practice, metastatic disease must be excluded by both choline PET and bone scan. Localization of cancer was carried out using multiparametric MRI of the prostate (T2-weighted, diffusion-weighted and dynamic contrast-enhanced imaging) with systematic or template prostate mapping biopsies. The primary outcome was a composite failure incorporating biochemical failure (BCF) and/or positive localized or distant imaging results and/or positive biopsy and/or systemic therapy and/or metastases/prostate cancer-specific death. The secondary outcome was BCF using the Phoenix-ASTRO definition (prostate-specific antigen [PSA] nadir + 2 ng/mL). We used Kaplan–Meier analysis and Cox proportional hazards regression to quantify the effect of the determinants on the endpoints. Results The mean (standard deviation [sd]) patient age at focal salvage HIFU was 69.8 (6.1) years and the median (interquartile range [IQR]) PSA pre-focal salvage HIFU was 5.5 (3.6–7.9) ng/mL. The median (IQR) follow-up was 35 (22–52) months. Patients were classified as having low- 2.7% (4/150), intermediate- 39.3% (59/150) and high-risk disease 41.3% (62/150) according to D'Amico classification, prior to focal salvage HIFU. Composite failure occurred in 61% of patients (91/150) and BCF occurred in 51.3% (77/150). The Kaplan–Meier composite endpoint-free survival (CEFS) rate at 3 years was 40% (95% confidence interval [CI] 31–50) for the entire group. Kaplan–Meier estimates of CEFS were 100%, 49% and 24% at 3 years in the low-, intermediate- and high-risk groups pre-salvage HIFU, respectively. The Kaplan–Meier biochemical disease-free survival (BDFS) rate at 3 years was 48% (95% CI 39–59) for the entire group. Kaplan–Meier estimates of BDFS were 100%, 61% and 32% at 3 years in the low-, intermediate- and high-risk groups pre-salvage HIFU, respectively. Complications included urinary tract infection (11.3%; 17/150), bladder neck stricture (8%; 12/150), recto-urethral fistula after one HIFU procedure (2%; 3/150) and osteitis pubis (0.7%; 1/150). Conclusion Focal salvage HIFU conferred a relatively low complication and side effect rate. CEFS and biochemical control in the short to medium term were reasonable, especially in this relatively high-risk cohort, but still low compared with current whole-gland salvage therapies. Focal salvage therapy may offer disease control in men at high risk whilst minimizing additional treatment morbidities.
Issue Date: 18-Jul-2017
Date of Acceptance: 4-Mar-2017
ISSN: 1464-4096
Publisher: Wiley
Start Page: 246
End Page: 256
Journal / Book Title: BJU International
Volume: 120
Issue: 2
Copyright Statement: This is the peer reviewed version of the following article: Kanthabalan, A., Peters, M., Van Vulpen, M., McCartan, N., Hindley, R. G., Emara, A., Moore, C. M., Arya, M., Emberton, M. and Ahmed, H. U. (2017), Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. BJU Int, 120: 246–256. , which has been published in final form at  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Keywords: Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
focal salvage HIFU
radiorecurrent prostate cancer
Analysis of Variance
Disease-Free Survival
Kaplan-Meier Estimate
Neoplasm Recurrence, Local
Prostatic Neoplasms
Retrospective Studies
Salvage Therapy
Treatment Outcome
Ultrasound, High-Intensity Focused, Transrectal
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine

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