Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications

Schmid, Florian; Schindele, Daniel; Mortezavi, Ashkan; Spitznagel, T.; Sulser, Tullio; Schostak, Martin; Eberli, Daniel

doi:10.1016/j.urolonc.2019.09.001

Cited by 26 publications

(28 citation statements)

References 31 publications

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“…The most common complications after focal therapy usually occur within the first 30 days after the intervention ( 22 ). These are often haematuria, infectious complications or catheter related issues such as pain, discomfort and urethral sloughing.…”

Section: Resultsmentioning

confidence: 99%

“…In case of a second failed TWOC a cystoscopy under general anesthesia is advised in order to rule-out the presence of obstructive necrotic tissue that would require a transurethral resection. The need for endoscopic interventions after focal treatments has become less frequent with the advent of more conservative ablation templates ( 22 , 27 ).…”

Section: Resultsmentioning

confidence: 99%

“…In the primary focal therapy setting, recto-urethral fistula is rare at 0-1% (12). Multiple RCT and prospective studies on different types of focal therapy confirm the low rates of this complication (22,(25)(26)(27)(28). The risk is highest when treatment is performed in a salvage setting and when cancer is located in the posterior part of the prostate and extracapsular extension is present.…”

Section: Rectal Toxicitymentioning

confidence: 98%

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Focal Therapy for Prostate Cancer: Complications and Their Treatment

et al. 2021

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Focal therapy is a modern alternative to selectively treat a specific part of the prostate harboring clinically significant disease while preserving the rest of the gland. The aim of this therapeutic approach is to retain the oncological benefit of active treatment and to minimize the side-effects of common radical treatments. The oncological effectiveness of focal therapy is yet to be proven in long-term robust trials. In contrast, the toxicity profile is well-established in randomized controlled trials and multiple robust prospective cohort studies. This narrative review summarizes the relevant evidence on complications and their management after focal therapy. When compared to whole gland treatments, focal therapy provides a substantial benefit in terms of adverse events reduction and preservation of genito-urinary function. The most common complications occur in the peri-operative period. Urinary tract infection and acute urinary retention can occur in up to 17% of patients, while dysuria and haematuria are more common. Urinary incontinence following focal therapy is very rare (0–5%), and the vast majority of patients recover in few weeks. Erectile dysfunction can occur after focal therapy in 0–46%: the baseline function and the ablation template are the most important factors predicting post-operative erectile dysfunction. Focal therapy in the salvage setting after external beam radiotherapy has a significantly higher rate of complications. Up to one man in 10 will present a severe complication.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Rectal Toxicitymentioning

confidence: 98%

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Focal Therapy for Prostate Cancer: Complications and Their Treatment

et al. 2021

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“…Of 847 studies identified, we included 20 in the final analysis (Figure -1): 1 randomised controlled trial (9), 10 prospective development studies (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and 9 retrospective case series (6,(20)(21)(22)(23)(24)(25)(26)(27). Across all the studies, 4209 patients were treated with focal HIFU.…”

Section: Evidenced Synthesismentioning

confidence: 99%

Available evidence on HIFU for focal treatment of prostate cancer: a systematic review

et al. 2022

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Purpose: Prostate cancer (PCa) is the second most common oncologic disease among men. Radical treatment with curative intent provides good oncological results for PCa survivors, although definitive therapy is associated with significant number of serious side-effects. In modern-era of medicine tissue-sparing techniques, such as focal HIFU, have been proposed for PCa patients in order to provide cancer control equivalent to the standard-of-care procedures while reducing morbidities and complications. The aim of this systematic review was to summarise the available evidence about focal HIFU therapy as a primary treatment for localized PCa. Material and methods: We conducted a comprehensive literature review of focal HIFU therapy in the MEDLINE database (PROSPERO: CRD42021235581). Articles published in the English language between 2010 and 2020 with more than 50 patients were included. Results: Clinically significant in-field recurrence and out-of-field progression were detected to 22% and 29% PCa patients, respectively. Higher ISUP grade group, more positive cores at biopsy and bilateral disease were identified as the main risk factors for disease recurrence. The most common strategy for recurrence management was definitive therapy. Six months after focal HIFU therapy 98% of patients were totally continent and 80% of patients retained sufficient erections for sexual intercourse. The majority of complications presented in the early postoperative period and were classified as low-grade.

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“…HIFU itself has already made an appearance in guidelines, concerning PC treatment options, although only as an investigational therapeutic tool, or as salvage therapy [134]. The most important benefit of HIFU is that it is minimally invasive when compared to surgical treatment, and it is devoid of systemic toxicity in comparison with androgen deprivation therapy (ADT) or chemotherapy, nevertheless possible adverse effects may occur quite frequently, and they include erectile dysfunction, urinary tract infections, rectal injuries, and more [135,136]. Properties of HIFU can be divided into a few groups -ablative and non-ablative (mechanical), immune, and biological effects; induced activity depends on a multitude of factors including frequency, pressure, duty cycle, and treatment time, achieved temperature, tissue susceptibility, and more.…”

Section: High-intensity Focused Ultrasoundmentioning

confidence: 99%

Boosting the Immune Response – Combining the Local and Immune Therapy for Prostate Cancer Treatment

Karwacki¹,

Szlasa²,

Sauer³

et al. 2022

Preprint

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Due to slow progression and susceptibility to radical forms of treatment low-grade PC is associ-ated with high overall survival (OS). With the clinical progression of PC the therapy is getting more complex. The immunosuppressive tumor microenvironment (TME) makes PC a difficult target for most immunotherapeutics. Its general immune resistance is established by i.e. immune evasion through Treg cells, synthesis of immunosuppressive mediators, and defective expression of surface neoantigens. The success of sipuleucel-T in clinical trials initiated several other clinical studies that specifically target the immune escape of the tumor and eliminate the immunosuppres-sive properties of TME. In the settings of PC treatment, this can be commonly achieved with radi-ation therapy (RT). Also, focal therapies usually applied for localized PC, such as high-intensity focused ultrasound (HIFU) therapy, cryotherapy, photodynamic therapy (PDT), or irreversible electroporation (IRE) were shown to boost anti-cancer response. Nevertheless, the present guide-lines restrict their application to localized and low-grade PC. This review explains how RT and focal therapies enhance the immune response. We also provide data supporting the combination of RT and focal treatments with immune therapies.

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Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications

Cited by 26 publications

References 31 publications

Focal Therapy for Prostate Cancer: Complications and Their Treatment

Focal Therapy for Prostate Cancer: Complications and Their Treatment

Available evidence on HIFU for focal treatment of prostate cancer: a systematic review

Boosting the Immune Response – Combining the Local and Immune Therapy for Prostate Cancer Treatment

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