Dr. Orczyk’s team at University College London has a prospective cohort of 1,032 men that have been treated with hemi-gland and focal HIFU.1 These men had significant unilateral disease, either GG1 & GG2 or GG2 & GG3 prostate cancer. Their group does not treat GG1 prostate cancer with HIFU. Furthermore, there must be a concordant mpMRI lesion and insignificant prostate cancer outside of the anterior zone is permitted. The template of ablation has changed over time and now includes a 5-9 mm margin around a lesion seen on mpMRI; retreatment is also permitted. Monitoring of these patients includes a combination of prostate-specific antigens (PSA) and mpMRIs, with PSAs every three months in order to assess a PSA nadir. Per protocol at one year includes an mpMRI +/- a biopsy (targeted +/- transperineal mapping), and systematic mpMRIs are repeated at 3, 5, and 10 years. A for-cause mpMRI is performed when the PSA significantly increases over the PSA nadir.
Among the 1,032 patients included, 63.4% were GG2, median baseline PSA was 7 ng/dL (IQR 4.9-9.7), median prostate volume was 36.5 cc (IQR 28-48), and 92.4% of tumors were visible on mpMRI. In their cohort, the median follow-up is currently 36 months (IQR 11-64 months; range 0-131 months). Treatment-related complications included 9.6% of patients requiring an endoscopic procedure (Clavien-Dindo Grade IIIb), 0.12% of patients suffering a rectourethral fistula (Grade IIIa), and 8.5% of patients having a urinary tract infection (Grade I).
With regards to oncologic outcomes, any cancer biopsy free survival (all Gleason grade [GG]) is as follows:
- 12-months: 90.8%
- 24- months: 79.3%
- 60-months: 53.5%
- 96-months: 40.6%
Overall, 26.3% of patients required retreatment, with the majority of these patients having retreatment HIFU (71.2%). The median time to retreatment was 26 months (IQR 13-46). Additional outcomes included: (i) time to radical treatment (median 36 months, IQR 14-60), (ii) systemic therapy rate (1.9%), (iii) biochemical recurrence after radiotherapy rate (7%), and (iv) distant metastasis rate (1.6%).
Presented by: Clément Orczyk, MD, PhD, Associate Professor of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
Written by: Zachary Klaassen, MD, MSc, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Augusta, Georgia, Twitter: @zklaassen_md at the Virtual 2020 EAU Annual Meeting #EAU20, July 17-19, 2020
1. Stabile, Armando, Clement Orczyk, Feargus Hosking‐Jervis, Francesco Giganti, Manit Arya, Richard G. Hindley, Louise Dickinson et al. "Medium‐term oncological outcomes in a large cohort of men treated with either focal or hemi‐ablation using high‐intensity focused ultrasonography for primary localized prostate cancer." BJU international 124, no. 3 (2019): 431-440.