Mp18-08 Focal Hifu for Treatment of Localised Prostate Cancer: A Multi-Centre Registry Experience

Abstract

INTRODUCTION AND OBJECTIVES: When focal therapy (FT) is performed with sufficient intensity to eradicate cancer, accurate evaluation for the extent of significant cancer (SC) is essential to avoid undertreatment. By D 0 Amico risk category of prostate cancer (PC), we assessed the possibility of underdiagnosis by MRI and biopsy for: 1) extra-prostatic extension (EPE) at the ablation field; and 2) SC left in untreated area. We then verified the applicability of quadrant-based regional FT to intermediate-and high-risk PC, compared with lowrisk PC.METHODS: We enrolled 203 PC patients in clinical stage T2 on digital rectal examination who underwent multiparametric MRI, systematic 14-core biopsy, and radical prostatectomy. MRI interpretation followed the Prostate Imaging Reporting and Data System version 2. Cancer distribution was analyzed using a quadrant basis. Anterior and posterior prostatic quadrants were assessed through 4 anterior/lateral cores and 4 posterior/lateral cores, respectively. Additional MRI-targeted sampling was included in the assessment of Gleason score (GS). SC was defined as a lesion with volume 0.5 mL and/or GS 4+3 and/or EPE. We consider that the absence of EPE is a precondition for FT and that the absence of SC is prerequisite for the untreated area. Each prostate was examined for EPE using MRI, and each quadrant was then assessed for SC using MRI and 4 biopsy cores.RESULTS: In total, 35/109/59 men were classified as low-/ intermediate-/high-risk cases, respectively. In each risk groups, radiological EPE (rEPE) features on MRI were absent in 31/49/21 men (89/45/36% of each group). Among men without rEPE features in each group, EPE was pathologically absent in 30/47/19 men (97/96/90%) (p ¼ 1.00 and 0.56 in intermediate-and high-risk groups, respectively, vs. the low-risk group). In men without rEPE features, SC was absent in 44/55/23 anterior quadrants (71/56/55%) and 46/55/22 posterior quadrants (74/56/52%). Negative predictive values of the combination of MRI and biopsy for SC were 95/96/100% in anterior quadrants (p ¼ 1.00 and 1.00 in intermediate-and high-risk groups, respectively, vs. the low-risk group) and 94/98/89% in posterior quadrants (p ¼ 0.58 and 0.61).CONCLUSIONS: In intermediate-and high-risk PC selected through MRI and biopsy, EPE is absent in 96% and 90% of men, respectively, and SC left in the untreated area is absent in 96-98% and 89-100% of quadrants, respectively, which suggests that FT is an option for intermediate-risk PC as well as low-risk PC. Although carefullyselected high-risk PC might also be a candidate for FT, further study using a larger cohort is needed.

Early-Medium-Term Outcomes of Primary Focal Cryotherapy to Treat Nonmetastatic Clinically Significant Prostate Cancer from a Prospective Multicentre Registry

“…Our primary outcome was failure free survival (FFS), defined as transition to radical, wholegland or systemic therapy as well as metastases/death as used in our previous reports of focal therapy (definition 1) (10,11). This is also the primary endpoint used in the PART randomised control trial (RCT) comparing focal with radical therapy (12).…”

“…Taimur T. Shah [1,2,3], Max Peters [4], David Eldred-Evans [1], Saiful Miah [1,2,3], Tet Yap [5], Nicholas A. Faure-Walker [5], Feargus Hosking-Jervis [1], Benjamin Thomas [3], Tim Dudderidge [6], Richard G. Hindley [7], Stuart McCracken [8], Damian Greene [9], Raj Nigam [12], Massimo Valerio [10], Suks Minhas [2], Mathias Winkler [1,2], Manit Arya* [1,2,3,11], Hashim U. Ahmed* [1,2] Introduction Currently, patients with non-metastatic clinically significant localised prostate cancer are offered either radical prostatectomy or radiotherapy. Both interventions have robust longterm cancer control outcomes but due to targeting the entire prostate confer significant negative effects on genitourinary function, particularly with regards to incontinence, urinary symptoms, erectile function and rectal side-effects (radiotherapy) (EF) (1,2).…”

Multiparametric MR Imaging of the Prostate after Treatment of Prostate Cancer

“…HIFU ablation causes coagulation necrosis in the targeted tissue by generation of a cavitation effect, and it is a good alternative in the management of moderately and well-differentiated localized prostate cancer and of local recurrence after EBRT (26). A recent multicenter study in the United Kingdom showed that a preponderance of treated patients (81%) were of intermediate risk, followed by low risk (13%), and high risk (6%), showing a wide range of use cases (27). Transurethral high-intensity US, a variant of HIFU, is less focused, delivering whole-gland ablation.…”