Focal Therapy for Localized Prostate Cancer with Either High Intensity Focused Ultrasound or Cryoablation: A Single Institution Experience

Tourinho-Barbosa, Rafael; Sánchez-Salas, Rafael; Claros, Oliver Rojas; Collura-Merlier, Sylvain; Bakavičius, Arnas; Carneiro, Ariê; Stabile, Armando; Moschini, Marco; Cathala, Nathalie; Tobias-Machado, Marcos; Cathelineau, Xavier

doi:10.1097/ju.0000000000000506

Cited by 71 publications

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“…The overall cancer recurrence rate in this study was 45.8%, including clinically significant and insignificant cancers. Recent FT trial data show similar rates of treatment failures among different modalities [ 23 , 24 ]. Major reasons for these high rates are the multifocality of PCa, imaging and biopsy errors, and inappropriate patient selection [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer

et al. 2020

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Purpose Focal therapies (FTs) are investigated within prospective studies on selected patients treated for localized prostate cancer (PCa). Benefits are preservation of genitourinary function and reduced complications, but follow-up is elaborate and is associated with uncertainty as cancer-free survival appears to be lower compared to standard radical treatments. The aim of this study was to analyse patient-reported acceptance of FT and evaluate factors associated with treatment decision regret. Methods 52 patients who received focal high-intensity focused ultrasound for low- to intermediate-risk PCa between 2014 and 2019 within two prospective trials were eligible for a survey regarding PCa-related treatment regret and quality-of-life (Clark’s scale) and the following potential predictors: sociodemographic variables, Charlson Comorbidity Index, subjective aging (AARC-10 SF), and general health-related quality-of-life (SF-12). Cancer persistence/recurrence (multiparametric MRI and fusion biopsy after 12 months) and functional outcomes (EPIC-26 UI/UIO/S) data were also included in this study. Results The overall survey response rate was 92.3% (48/52 patients). Median follow-up was 38 months (interquartile range = 25–50 months). In total, ten patients (20.8%) reported treatment decision regret. In univariable analyses, a clinically meaningful increase in urinary incontinence showed a significant association (OR 4.43; 95% CI 0.99–20.53; p = 0.049) with regret. Cancer recurrence (OR 12.31; 95% CI 1.78–159.26; p = 0.023) and general health worry as a domain of Clark’s scale (OR 1.07; 95% CI 1.03–1.14; p < 0.01) were predictors of regret in a multivariable logistic regression model (AUC = 0.892). Conclusion Acceptance of FT is comparable to standard treatments. Extensive follow-up including regular PSA testing does not cause additional regret but careful patient selection and information before FT is crucial.

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Section: Discussionmentioning

confidence: 99%

Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer

et al. 2020

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“…All procedures were performed by two experienced surgeons (>100 partial gland HIFU ablations before the study initiation). All men provided written informed consent and the study was approved by local IRB ( 11 - 13 ).…”

Section: Methodsmentioning

confidence: 99%

Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center

et al. 2020

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Background: Focal therapy (FT) for localized prostate cancer (PCa) treatment is raising interest. New technological mpMRI-US guided FT devices have never been compared with the previous generation of ultrasound-only guided devices. Materials and Methods: We retrospectively analyzed prospectively recorded data of men undergoing FT for localized low-or intermediate-risk PCa with US-(Ablatherm®-2009 to 2014) or mpMRI-US (Focal One®-from 2014) guided HIFU. Follow-up visits and data were collected using internationally validated questionnaires at 1, 2, 3, 6 and 12 months. Results: We included n=88 US-guided FT HIFU and n=52 mpMRI-US guided FT HIFU respectively. No major baseline differences were present except higher rates of Gleason 3+4 for the mpMRI-US group. No major differences were present in hospital stay (p=0.1), catheterization time (p=0.5) and complications (p=0.2) although these tended to be lower in the mpMRI-US group (6.8% versus 13.2% US FT group). At 3 months mpMRI-US guided HIFU had significantly lower urine leak (5.1% vs. 15.9%, p=0.04) and a lower drop in IIEF scores (2 vs. 4.2, p=0.07). Of those undergoing 12-months control biopsy in the mpMRI-US-guided HIFU group, 26% had residual cancer in the treated lobe. Conclusion: HIFU FT guided by MRI-US fusion may allow improved functional outcomes and fewer complications compared to US-guided HIFU FT alone. Further analysis is needed to confirm benefits of mpMRI implementation at a longer follow-up and on a larger cohort of patients.

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“…Ten SRs were eligible for inclusion [17][18][19][20][21][22][23][24][25][26]. Thirteen comparative studies were excluded, the majority of which included fewer than 50 patients in at least one study arm, or incorporated whole-gland ablative therapy mixed with FT as the index intervention, or used whole-gland ablative therapy as a comparator ( Supplementary Table 1) [27][28][29][30][31][32][33][34][35][36][37][38][39]. In addition, 45 full-text SRs were excluded; the commonest reason for exclusion was inclusion of whole-gland treatment with FT in the analysis (ie, contamination).…”

Section: Quantity Of the Evidence Identifiedmentioning

confidence: 99%

A Systematic Review of Focal Ablative Therapy for Clinically Localised Prostate Cancer in Comparison with Standard Management Options: Limitations of the Available Evidence and Recommendations for Clinical Practice and Further Research

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et al. 2021

European Urology Oncology

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Focal Therapy for Localized Prostate Cancer with Either High Intensity Focused Ultrasound or Cryoablation: A Single Institution Experience

Cited by 71 publications

References 0 publications

Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer

Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer

Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center

A Systematic Review of Focal Ablative Therapy for Clinically Localised Prostate Cancer in Comparison with Standard Management Options: Limitations of the Available Evidence and Recommendations for Clinical Practice and Further Research

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