A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Non-metastatic Prostate Cancer

Background: Clinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects.

Objective: To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate. 

Design, setting, and participants: This was a prospective study of 625 consecutive patients with nonmetastatic clinically significant PCa undergoing focal HIFU therapy (Sonablate) in secondary care centres between January 1, 2006 and December 31, 2015. A minimum of 6-mo follow-up was available for599 patients. Intermediate- or high-risk PCa was found in 505 patients (84%).

Intervention: Disease was localised using multiparametric magnetic resonance imaging (mpMRI) combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included prostate-specific antigen (PSA) measurement, 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: The median follow-up was 56 mo (interquartile range [IQR] 35–70). The median age was 65 yr (IQR 61–71) and median preoperative PSA was 7.2 ng/ml (IQR 5.2–10.0). FFS was 99% (95% confidence interval [CI] 98–100%) at 1 yr, 92% (95% CI 90–95%) at 3 yr, and 88% (95% 85–91%) at 5 yr. For the whole patient cohort, metastasis-free, cancer-specific, and overall survival at 5 yr was 98% (95% CI 97–99%), 100%, and 99% (95% CI 97–100%), respectively. Among patients who returned validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than 1 pad/d. Limitations include the lack of long-term follow-up.

Conclusions: Focal therapy for select patients with clinically significant nonmetastatic prostate cancer is effective in the medium term and has a low probability of side effects.

Patient summary: In this multicentre study of 625 patients undergoing focal therapy using high-intensity focused ultrasound (HIFU), failure-free survival, metastasis-free survival, cancer-specific survival, and overall survival were 88%, 98%, 100%, and 99%, respectively. Urinary incontinence (any pad use) was 2%. Focal HIFU therapy for patients with clinically significant prostate cancer that has not spread has a low probability of side effects and is effective at 5 yr.

Stephanie Guillaumier,1,2 Max Peters,3 Manit Arya,2,4,5 Naveed Afzal,6 Susan Charman,1 Tim Dudderidge,7 Feargus Hosking-Jervis,1,8 Richard G. Hindley,9 Henry Lewi,10 Neil McCartan,1,2 Caroline M. Moore,1,2 Raj Nigam,11 Chris Ogden,12 Raj Persad,13 Karishma Shah,1 Jan van der Meulen,14 Jaspal Virdi,5 Mathias Winkler,4 Mark Emberton,1,2 Hashim U. Ahmed 1,4,8

1. Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
2. Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
3. Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands
4. Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
5. Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom
6. Department of Urology, Dorset County Hospital NHS Trust, Dorset, United Kingdom
7. Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
8. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
9. Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom
10. Springfield Hospital, Chelmsford, United Kingdom
11. Department of Urology, Royal County Surrey Hospital NHS Trust, Guildford, United Kingdom
12. Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
13. Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
14. London School of Hygiene and Tropical Medicine, London, United Kingdom

European Association of Urology. October 2018 Volume 74, Issue 4, Pages 422–429

DOI: https://doi.org/10.1016/j.eururo.2018.06.006