Evaluation of functional outcomes following a second focal-HIFU in men with primary localised, non-metastatic prostate cancer; Results from the High Intensity Focused Ultrasound Evaluation and Assessment of Treatment (HEAT) Registry.

To assess change in functional outcomes after second focal-HIFU compared to one focal-HIFU treatment.

In this multi-centre study (2005-2016), 821 men underwent focal-HIFU for localised non-metastatic prostate cancer. PROMS on IPSS, pad usage and erectile function (EF-score) were prospectively collected for up to 3 years. Inclusion criteria were men who had completed at least one follow-up questionnaire. The primary outcome was comparison of change in functional outcomes between baseline and follow-up after one focal-HIFU or second focal-HIFU using IPSS, EPIC and IIEF questionnaires.

Of 821 men, 654 had one focal-HIFU and 167 had a second focal-HIFU. 355 (54.3%) men undergoing one focal-HIFU and 65 (38.9%) having second focal-HIFU returned follow-up questionnaires, respectively. Mean age and PSA were 66.4 and 65.6 years, and 7.9 and 8.4 ng/ml respectively. After one focal-HIFU, mean change in IPSS was -0.03 (p=0.02) and IIEF (EF-score) -0.4 (p=0.02) at 1-2 years with no subsequent decline. Absolute rates of erectile dysfunction increased from 9.9% to 20.8% (p=0.08), leak-free continence decreased from 77.9% to 72.8% (p=0.06) and pad-free continence from 98.6% to 94.8% (p= 0.07) at 1-2 years, respectively. IPSS prior to second focal-HIFU compared to baseline IPSS prior to first focal-HIFU was lower by -1.3 (p=0.02), but mean IPSS change was +1.4 at 1-2 years (p=0.03) and +1.2 at 2-3 years (p=0.003) after second focal-HIFU. Mean change in EF-score after second focal-HIFU was -0.2 at 1-2 years(p=0.60) and -0.5 at 2-3 years(p=0.10) with 17.8% and 6.2% new erectile dysfunction. New pad use was 1.8% at 1-2 years and 2.6% at 2-3 years.

A second focal-HIFU procedure causes minor detrimental effects in urinary and erectile function. Data can be used to counsel patients with non-metastatic prostate cancer prior to considering HIFU therapy.

BJU international. 2020 Jan 23 [Epub ahead of print]

Catherine E Lovegrove, Max Peters, Stephanie Guillaumier, Manit Arya, Naveed Afzal, Tim Dudderidge, Feargus Hosking-Jervis, Richard J Hindley, Henry Lewi, Neil McCartan, Caroline M Moore, Raj Nigam, Chris Ogden, Raj Persad, Jaspal Virdi, Mathias Winkler, Mark Emberton, Hashim U Ahmed, Taimur T Shah, Suks Minhas

Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK., University Medical Center Utrecht, Department of Radiation Oncology, Cancer Center, Utrecht, Netherlands., Division of Surgery and Interventional Sciences, University College London, London, UK., Department of Urology, Dorset County Hospital NHS Trust, Dorset, UK., Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK., Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK., Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, UK., Springfield Hospital, Chelmsford, Essex, UK., Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK., Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK., Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.