Focal High-intensity Focused Ultrasound Targeted Hemiablation for Unilateral Prostate Cancer: A Prospective Evaluation of Oncologic and Functional Outcomes.

In selected patients with unilateral, organ-confined prostate cancer (PCa), hemiablation of the affected lobe might be feasible to achieve acceptable cancer control with fewer complications.

To assess the oncologic and functional outcomes of focal high-intensity focused ultrasound (HIFU) hemiablation in unilateral organ-confined PCa.

Single-center prospective evaluation of HIFU hemiablation for unilateral organ-confined PCa was performed from July 2009 through December 2013.

Cancer localization was done with transrectal ultrasound-guided biopsy and multiparametric magnetic resonance imaging followed by HIFU hemiablation.

Oncologic outcomes were analyzed with control biopsies and prostate-specific antigen (PSA) measurement. Functional outcomes were assessed with validated questionnaires for genitourinary symptoms.

Of 71 HIFU hemiablation patients, 67 completed the study protocol. The mean age was 70. 2 yr (standard deviation: 6. 8 yr), and median PSA was 6. 1 ng/ml (interquartile range [IQR]: 1. 6-15. 5 ng/ml). Median maximum cancer-core length was 3mm (IQR: 2-10mm), and total cancer length was 6. 5mm (IQR: 2-24mm). Gleason score was 6 (3+3) in 58 patients (86. 6%) and 7 (3+4) in 9 patients (13. 4%). Median follow-up was 12 mo (IQR: 6-50 mo), and at 12 mo, 56 of 67 patients had a negative control biopsy in the treated lobe. At 3 mo, all patients were continent, and potency was maintained in 11 of 21 preoperatively potent patients (confidence interval, 0. 18-0. 69). Complications included 8% Clavien-Dindo grade 2 and 2. 8% grade 3 events.

Focal HIFU hemiablation appears to achieve acceptable oncologic outcomes with low morbidity and minimal functional changes. Longer follow-up will establish future considerations.

This study showed that high-intensity focused ultrasound hemiablation in selected patients with unilateral organ-confined prostate cancer can be used for satisfactory cancer control with minimal effect on genitourinary functions.

European urology. 2015 Jul 08 [Epub ahead of print]

Ernesto R Cordeiro Feijoo, Arjun Sivaraman, Eric Barret, Rafael Sanchez-Salas, Marc Galiano, Francois Rozet, Dominique Prapotnich, Nathalie Cathala, Annick Mombet, Xavier Cathelineau

Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. , Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. , Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. , Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. , Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. , Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. , Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. , Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. , Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.

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