EAU 2020: Midterm Oncological Results of Focal therapy: HIFU Hemi-Ablation

(UroToday.com) Focal therapy for prostate cancer was featured as a thematic session at the EAU 2020 virtual meeting, including a discussion on oncologic outcomes of high-intensity focused ultrasound (HIFU) hemi-ablation by Jonathan Olivier, MD, MSc. According to Dr. Olivier, inclusion criteria for hemi-gland ablation are as follows:

  • Primary treatment for GG1, GG2, and low volume GG3
  • Unilateral tumors (can accept one contralateral microfocus of GG1)
  • MRI: visible tumors proven by targeted biopsy
  • Location: post-lateral peripheral zone base and mid gland
  • Distance tumor to apex: >15 mm
  • Definition of clinically significant prostate cancer: GG2 or GG1 + MCCL > 6 mm + > 3 systematic positive biopsies
The energy used is focused high-intensity ultrasound energy (Ablatherm and Focal-one), with a template of posterior hemiablation (with a distance of 5 mm from the sagittal midline):

HighIntensityUltrasound_EAU2020.png
Dr. Olivier adds a 10 mm margin to the edge of mpMRI-visible lesions and the urethral catheter is removed on day 2 after treatment. Generally, he does not perform a pre-HIFU TURP. Dr. Olivier follows patients with a PSA every six months and DRE every year following treatment. Per-protocol, at one year he will perform an MRI + systematic biopsy +/- targeted biopsy. After one year he will perform for cause mpMRIs + biopsies for men with a PSA velocity of >= 0.5 ng/mL/year.

In Dr. Olivier’s experience with 71 patients, the median age was 65 years of age (IQR 60-69), median baseline PSA was 6.3 (IQR 4.8-8.0), and the most common grade group was GG2 (52%). The median prostate volume was 42cc (IQR 32-59) and 100% of patients had MRI visible lesions. The median follow-up was 57 months (IQR 26-78). There were no Clavien-Dindo >2 complications, however 29% had Grade 1 and 28% had Grade 2 complications, with the most common complication hematuria (24%). The clinically significant prostate cancer RFS rates are as follows:
  • 1 year: 98% (95% CI 95.9 to 100)
  • 3 years: 77% (95% CI 66.8 to 89.1)
  • 5 years: 65% (95% CI 53.6 to 80.4)
There were 9 patients (13%) that required retreatment at a median 23 months after the first treatment and to date no patients have required 2+ retreatments.

Finally, the radical treatment free-survival rates are as follows:
  • 1 year: 100%
  • 3 years: 83% (95% CI 73.9-94)
  • 5 years: 69% (95% CI 57.6-84)
Eleven patients ultimately underwent radical prostatectomy with 4 patients (36%) having biochemical recurrence during the follow-up period.

Presented by: Jonathan Olivier, MD, MSc, CHRU Lille, Lille University, Lille, France

Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Augusta, GA, USA, Twitter: @zklaassen_md, at the Virtual 2020 EAU Annual Meeting #EAU20, July 17-19, 2020. 
 
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