A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer

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Title: A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer
Authors: Guillaumier, S
Peters, M
Arya, M
Afzal, N
Charman, S
Dudderidge, T
Hosking-Jervis, F
Hindley, RG
Lewi, H
McCartan, N
Moore, CM
Nigam, R
Ogden, C
Persad, R
Shah, K
Van der Meulen, J
Virdi, J
Winkler, M
Emberton, M
Ahmed, HU
Item 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.
Issue Date: Oct-2018
Date of Acceptance: 1-Jun-2018
URI: http://hdl.handle.net/10044/1/60631
DOI: https://doi.org/10.1016/j.eururo.2018.06.006
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/)
Sponsor/Funder: Wellcome Trust
University College London Hospitals Charity
Funder's Grant Number: 204998/Z/16/Z
1348
Keywords: 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
Outcome Assessment (Health Care)
Male
Ultrasonic Waves
United Kingdom
Urology & Nephrology
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2018-06-28
Appears in Collections:Division of Surgery
Faculty of Medicine



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