A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer

Abstract

BackgroundClinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects.ObjectiveTo report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate.Design, setting, and participantsThis was a prospective study of 625 consecutive patients with nonmetastatic clinically significant PCa undergoing focal HIFU therapy (Sonablate) in secondary care centres between January 1, 2006 and December 31, 2015. A minimum of 6-mo follow-up was available for599 patients. Intermediate- or high-risk PCa was found in 505 patients (84%).InterventionDisease was localised using multiparametric magnetic resonance imaging (mpMRI) combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included prostate-specific antigen (PSA) measurement, mpMRI, and biopsies.Outcome measurements and statistical analysisThe primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality.Results and limitationsThe median follow-up was 56 mo (interquartile range [IQR] 35–70). The median age was 65 yr (IQR 61–71) and median preoperative PSA was 7.2 ng/ml (IQR 5.2–10.0). FFS was 99% (95% confidence interval [CI] 98–100%) at 1 yr, 92% (95% CI 90–95%) at 3 yr, and 88% (95% 85–91%) at 5 yr. For the whole patient cohort, metastasis-free, cancer-specific, and overall survival at 5 yr was 98% (95% CI 97–99%), 100%, and 99% (95% CI 97–100%), respectively. Among patients who returned validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than 1 pad/d. Limitations include the lack of long-term follow-up.ConclusionsFocal therapy for select patients with clinically significant nonmetastatic prostate cancer is effective in the medium term and has a low probability of side effects.Patient summaryIn this multicentre study of 625 patients undergoing focal therapy using high-intensity focused ultrasound (HIFU), failure-free survival, metastasis-free survival, cancer-specific survival, and overall survival were 88%, 98%, 100%, and 99%, respectively. Urinary incontinence (any pad use) was 2%. Focal HIFU therapy for patients with clinically significant prostate cancer that has not spread has a low probability of side effects and is effective at 5 yr.

Prospective Feasibility Study of Single-Shot Antibiotic Prophylaxis in Transrectal Focal Ablation of Prostate Cancer

“…An overview of HIFU studies is presented in Table 5. For focal HIFU or HIFU hemiablation, UTI rates range between 5.6 and 17.9% [1,5,11,16,17]. Only the trial by Ahmed et al [11] reported in more detail on perioperative antibiotic treatment using prophylaxis with gentami-cin or targeted therapy in addition to a fluoroquinolone therapy for 7 days post treatment.…”

“…Organ-sparing focal therapies of localized prostate cancer aim to efficiently treat intraprostatic cancer lesions and to avoid side effects of whole gland treatments. There is a growing body of studies presenting oncological and functional outcomes for patients treated with experimental therapies such as high-intensity focused ultrasound (HIFU) [1][2][3][4]. However, when reporting adverse events, studies commonly focus on those events affecting genitourinary function, which are voiding, continence, and potency.…”

Phosphoribosyl pyrophosphate synthetases 2 knockdown inhibits prostate cancer progression by suppressing cell cycle and inducing cell apoptosis

“…Prostate cancer (PCa) is the fifth leading causes of cancer-related death and the most common human carcinoma among men worldwide [1]. Androgen deprived therapy (ADT) or platinum-based chemotherapy or other systemic treatment has been proved to partial effectively to alleviate symptoms for advanced prostate adenocarcinoma patients; however, the overall survival benefit is still limited [2]. A growing number of evidence highlights that exceptional overexpression of apoptosis resistant proteins, and dysregulation of proliferation-related genes is obsessed in the advance of PCa [3,4].…”

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“…Both preclinical and clinical results have demonstrated clinical efficiency of direct ablation and treatment by HIFU in areas such as prostate cancer, uterine fibroids, breast cancer, thyroid cancer, bone metastasis, essential tremor, brain tumors, pancreas cancer, and liver cancer . In these applications, HIFU systems are often combined with magnetic resonance imaging systems (MR) as integrated therapeutic systems, with MR guiding the positioning of the HIFU focal point in the organ being target for treatment, so‐called magnetic resonance‐guided focused ultrasound (MRgFUS).…”