Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience

Deepika Reddy; Max Peters; Taimur T Shah; Marieke van Son; Mariana Bertoncelli Tanaka; Philipp M Huber; Derek Lomas; Arnas Rakauskas; Saiful Miah; David Eldred-Evans; Stephanie Guillaumier; Feargus Hosking-Jervis; Ryan Engle; Tim Dudderidge; Richard G Hindley; Amr Emara; Raj Nigam; Neil McCartan; Massimo Valerio; Naveed Afzal; Henry Lewi; Clement Orczyk; Chris Ogden; Iqbal Shergill; Raj Persad; Jaspal Virdi; Caroline M Moore; Manit Arya; Mathias Winkler; Mark Emberton; Hashim U Ahmed

doi:10.1016/j.eururo.2022.01.005

Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience

Eur Urol. 2022 Apr;81(4):407-413. doi: 10.1016/j.eururo.2022.01.005. Epub 2022 Feb 3.

Authors

Deepika Reddy¹, Max Peters², Taimur T Shah³, Marieke van Son², Mariana Bertoncelli Tanaka⁴, Philipp M Huber⁵, Derek Lomas⁶, Arnas Rakauskas⁷, Saiful Miah⁸, David Eldred-Evans⁹, Stephanie Guillaumier¹⁰, Feargus Hosking-Jervis⁹, Ryan Engle⁹, Tim Dudderidge¹¹, Richard G Hindley¹², Amr Emara¹³, Raj Nigam¹⁴, Neil McCartan¹⁰, Massimo Valerio⁷, Naveed Afzal¹⁵, Henry Lewi¹⁶, Clement Orczyk¹⁰, Chris Ogden¹⁷, Iqbal Shergill¹⁸, Raj Persad¹⁹, Jaspal Virdi²⁰, Caroline M Moore²¹, Manit Arya²², Mathias Winkler³, Mark Emberton²¹, Hashim U Ahmed²³

Affiliations

¹ Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: Deepika.reddy06@imperial.ac.uk.
² Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands.
³ Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
⁴ Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
⁵ Urologie St. Anna, Luzern, Switzerland.
⁶ Department of Urology, Mayo Clinic, Rochester, MN, USA.
⁷ Urology Department, Lausanne University Hospital, Lausanne, Switzerland.
⁸ Department of Urology, Buckinghamshire Hospitals NHS Trust, Amersham, UK.
⁹ Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁰ Department of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital, London, UK.
¹¹ Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
¹² Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK; BMI The Hampshire Clinic, Basingstoke, UK.
¹³ Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK; Department of Urology, Ain Shams University Hospitals, Cairo, Egypt.
¹⁴ Department of Urology, Royal Surrey NHS Foundation Trust, UK; BMI Mount Alvernia Hospital, Guildford, UK.
¹⁵ Dorset County Hospital Foundation Trust, Dorchester, UK.
¹⁶ Springfield Hospital, Chelmsford, UK.
¹⁷ Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
¹⁸ Department of Urology, Wrexham Maelor Hospital, Wrexham, UK.
¹⁹ North Bristol NHS Trust, Westbury on Trym, Bristol, UK.
²⁰ Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK.
²¹ Department of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital, London, UK; Princess Grace Hospital, London, UK; King Edward VII Hospital, London, UK.
²² Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Interventional Sciences, University College London, London, UK; University College Hospital, London, UK.
²³ Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; King Edward VII Hospital, London, UK; Cromwell Hospital, London, UK.

PMID: 35123819
DOI: 10.1016/j.eururo.2022.01.005

Abstract

Background: Focal therapy aims to treat areas of cancer to confer oncological control whilst reducing treatment-related functional detriment.

Objective: To report oncological outcomes and adverse events following focal high-intensity focused ultrasound (HIFU) for treating nonmetastatic prostate cancer.

Design, setting, and participants: An analysis of 1379 patients with ≥6 mo of follow-up prospectively recorded in the HIFU Evaluation and Assessment of Treatment (HEAT) registry from 13 UK centres (2005-2020) was conducted. Five or more years of follow-up was available for 325 (24%) patients. Focal HIFU therapy used a transrectal ultrasound-guided device (Sonablate; Sonacare Inc., Charlotte, NC, USA).

Outcome measurements and statistical analysis: Failure-free survival (FFS) was primarily defined as avoidance of no evidence of disease to require salvage whole-gland or systemic treatment, or metastases or prostate cancer-specific mortality. Differences in FFS between D'Amico risk groups were determined using a log-rank analysis. Adverse events were reported using Clavien-Dindo classification.

Results and limitations: The median (interquartile range) age was 66 (60-71) yr and prostate-specific antigen was 6.9 (4.9-9.4) ng/ml with D'Amico intermediate risk in 65% (896/1379) and high risk in 28% (386/1379). The overall median follow-up was 32 (17-58) mo; for those with ≥5 yr of follow-up, it was 82 (72-94). A total of 252 patients had repeat focal treatment due to residual or recurrent cancer; overall 92 patients required salvage whole-gland treatment. Kaplan-Meier 7-yr FFS was 69% (64-74%). Seven-year FFS in intermediate- and high-risk cancers was 68% (95% confidence interval [CI] 62-75%) and 65% (95% CI 56-74%; p = 0.3). Clavien-Dindo >2 adverse events occurred in 0.5% (7/1379). The median 10-yr follow-up is lacking.

Conclusions: Focal HIFU in carefully selected patients with clinically significant prostate cancer, with six and three of ten patients having, respectively, intermediate- and high-risk cancer, has good cancer control in the medium term.

Patient summary: Focal high-intensity focused ultrasound treatment to areas of prostate with cancer can provide an alternative to treating the whole prostate. This treatment modality has good medium-term cancer control over 7 yr, although 10-yr data are not yet available.

Keywords: Focal therapy; High-intensity focussed ultrasound; Oncological outcomes; Prostate cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Male
Neoplasm Recurrence, Local / pathology
Prostate / pathology
Prostate-Specific Antigen
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / pathology
Prostatic Neoplasms* / therapy
Salvage Therapy / methods
Treatment Outcome
Ultrasound, High-Intensity Focused, Transrectal* / adverse effects
Ultrasound, High-Intensity Focused, Transrectal* / methods

Substances

Prostate-Specific Antigen

Grants and funding

204998/Z/16/Z/WT_/Wellcome Trust/United Kingdom