Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort.

High-intensity focused ultrasound (HIFU) is a minimally-invasive treatment for nonmetastatic prostate cancer.

To report medium-term outcomes in men receiving primary whole-gland HIFU from a national multi-centre registry cohort.

Five-hundred and sixty-nine patients at eight hospitals were entered into an academic registry.

Whole-gland HIFU (Sonablate 500) for primary nonmetastatic prostate cancer. Redo-HIFU was permitted as part of the intervention.

Our primary failure-free survival outcome incorporated no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included adverse events and genitourinary function.

Mean age was 65 yr (47-87 yr). Median prostate-specific antigen was 7.0 ng/ml (interquartile range 4.4-10.2). National Comprehensive Cancer Network low-, intermediate-, and high-risk disease was 161 (28%), 321 (56%), and 81 (14%), respectively. One hundred and sixty three of 569 (29%) required a total of 185 redo-HIFU procedures. Median follow-up was 46 (interquartile range 23-61) mo. Failure-free survival at 5 yr after first HIFU was 70% (95% confidence interval [CI]: 64-74). This was 87% (95% CI: 78-93), 63% (95% CI: 56-70), and 58% (95% CI: 32-77) for National Comprehensive Cancer Network low-, intermediate-, and high-risk groups, respectively. Fifty eight of 754 (7.7%) had one urinary tract infection, 22/574 (2.9%) a recurrent urinary tract infection, 22/754 (3%) epididymo-orchitis, 227/754 (30%) endoscopic interventions, 1/754 (0.13%) recto-urethral fistula, and 1/754 (0.13%) osteitis pubis. Of 206 known to be pad-free pre-HIFU, 183/206 (88%) remained pad free, and of 236 with good baseline erectile function, 91/236 (39%) maintained good function. The main limitation is lack of long-term data.

Whole-gland HIFU is a repeatable day-case treatment that confers low rates of urinary incontinence. Disease control at a median of just under 5 yr of follow-up demonstrates its potential as a treatment for nonmetastatic prostate cancer. Endoscopic interventions and erectile dysfunction rates are similar to other whole-gland treatments.

In this report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.

European urology. 2016 Mar 04 [Epub ahead of print]

Louise Dickinson, Manit Arya, Naveed Afzal, Paul Cathcart, Susan C Charman, Andrew Cornaby, Richard G Hindley, Henry Lewi, Neil McCartan, Caroline M Moore, Senthil Nathan, Chris Ogden, Raj Persad, Jan van der Meulen, Shraddha Weir, Mark Emberton, Hashim U Ahmed

Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK., Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK; Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK., Department of Urology, Dorset County Hospital, Dorchester, UK., Department of Urology, UCLH NHS Foundation Trust, London, UK., Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK., Department of Urology, Dorset County Hospital, Dorchester, UK., Department of Urology, Basingstoke Hospital, Hampshire Hospitals NHS Foundation Trust, Hampshire, UK., Department of Urology, Broomfield Hospital, Mid Essex NHS Trust, Chelmsford, UK., Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK., Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK., Department of Urology, UCLH NHS Foundation Trust, London, UK., Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK., Department of Urology, North Bristol NHS Trust, Bristol, UK., Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK., Department of Urology, UCLH NHS Foundation Trust, London, UK., Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK., Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK. Electronic address: .

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