To report our intermediate outcomes of the use of focal ablation for treating significant unilateral prostate cancer. This technique was adopted in our centre ten years ago. With improving diagnostic accuracy of index prostate cancer lesions and a low side-effect profile, use of focal HIFU ablation is increasing.
Patients were diagnosed using PSA, multi-parametric MRI and template transperineal biopsies. Focal ablation of significant cancer was performed with the Sonablate device. Follow-up consisted of MRI scanning, PSA, validated questionnaires, biopsy for cause, and redo HIFU if required as part of the treatment strategy.
107 men underwent focal HIFU. 88% had intermediate/high risk disease, and the mean pre-HIFU PSA was 7.7. 31% had high volume Gleason 6 disease, 55% had Gleason 3+4 disease, and 13% had Gleason ≥ 4+3 disease. 54% received a hemi-ablation, 9% a focal ablation, and 40% a quadrant ablation. Median follow-up was 30 months, subjects' PSA dropped to an average 71% nadir. 8% had biochemical recurrence and 11% required adjuvant treatment. Freedom from additional procedures for clinically significant recurrent disease, including redo-HIFU, was 85.5%. Post-operative complications included 1% new use of pads, 1.9% urethral stricture, 2.8% post-HIFU TURP, and new onset ED of 14%.
In a carefully chosen cohort of patients for focal HIFU our results suggest acceptable oncological control with minimal post-operative morbidity. Further studies are required to establish this technique as a less morbid alternative to radical therapy.
Urology. 2019 Aug 23 [Epub ahead of print]
M J Johnston, A Emara, M Noureldin, S Bott, R G Hindley
Basingstoke and North Hampshire Hospital, Department of Urology. Electronic address: ., Basingstoke and North Hampshire Hospital, Department of Urology., Frimley Park Hospital, Department of Urology.