MP18-08 FOCAL HIFU FOR TREATMENT OF LOCALISED PROSTATE CANCER: A MULTI-CENTRE REGISTRY EXPERIENCE

Article (PDF Available)inThe Journal of Urology 195(4):e195 · April 2016with 36 Reads
DOI: 10.1016/j.juro.2016.02.2709
MP18-07
APPLICABILITY ANALYSIS OF FOCAL THERAPY TO
INTERMEDIATE- AND HIGH-RISK PROSTATE CANCER
Yoh Matsuoka*, Noboru Numao, Kazutaka Saito, Hiroshi Tanaka,
Masaharu Inoue, Masaya Ito, Soichiro Yoshida, Minato Yokoyama,
Junichiro Ishioka, Yasuhisa Fujii, Kazunori Kihara, Tokyo, Japan
INTRODUCTION AND OBJECTIVES: When focal therapy (FT)
is performed with sufcient intensity to eradicate cancer, accurate
evaluation for the extent of signicant cancer (SC) is essential to avoid
undertreatment. By D0Amico 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 eld; and 2) SC left in
untreated area. We then veried the applicability of quadrant-based
regional FT to intermediate- and high-risk PC, compared with low-
risk 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 interpre-
tation 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 dened 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 classied 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%)
(p¼1.00 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
(p¼1.00 and 1.00 in intermediate- and high-risk groups, respectively,
vs. the low-risk group) and 94/98/89% in posterior quadrants (p¼0.58
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 carefully-
selected high-risk PC might also be a candidate for FT, further study
using a larger cohort is needed.
Source of Funding: none
MP18-08
FOCAL HIFU FOR TREATMENT OF LOCALISED PROSTATE
CANCER: A MULTI-CENTRE REGISTRY EXPERIENCE
Stephanie Guillaumier*, Sami Hamid, Susan Charman,
Susan Charman, Jan van der Meulen, Neil McCartan, Karishma Shah,
London, United Kingdom; Richard Hindley, Basingstoke, United
Kingdom; Raj Nigam, Surrey, United Kingdom; Tim Dudderidge,
Southampton, United Kingdom; N Afzal, A Cornaby, Dorset, United
Kingdom; H Lewi, Chelmsford, United Kingdom; Raj Persad, Bristol,
United Kingdom; J Virdi, Harlow, United Kingdom; Caroline Moore,
London, United Kingdom; Manit Arya, Harlow, United Kingdom;
Mark Emberton, Hashim Uddin Ahmed, London, United Kingdom
INTRODUCTION AND OBJECTIVES: Focal therapy using
High Intensity Focused Ultrasound (HIFU) in the treatment of localised
prostate cancer has been shown to provide encouraging short-term
disease control with a low genito-urinary side effect prol. Our UK
prospective academic HIFU registry incorporates over 2000 cases from
8 centres that were treated with HIFU, spanning from 2004 to 2015. We
report on the medium term oncological and functional outcomes of
those treated wth focal HIFU.
METHODS: 625 patients diagnosd with T1aN0MO to T3bN0M0
prostate cancer were treated with focal HIFU. The diagnostic pathway
involved a multi-parametric MRI followed by transperineal mapping bi-
opsies and/or MR-targeted biopsies. Metastatic disease was excluded
in the intermediate- and high-risk patients by radioisotope bone scan
and/or cross-sectional CT. Focal HIFU was carried out by quadrant or
hemi-ablation of the prostate gland depending on disease location.
Some patients underwent index lesion ablation alone, provided that the
untreated area had no more than Gleason 6 disease with a maximum
core length of 5mm. Patients were followed-up using PSA levels, as
well as repeat prostate biopsies and MRI, if necessary.
RESULTS: Of 625 patients, 80 (13%), 491 (81%) and 39 (6%)
had low, intermediate and high-risk disease, respectively. With a
median follow-up of 56 (IQR 33-70) months. Median pre-operative
PSA was 7.1 (IQR 5.1-9.9). Median PSA nadir was 1.7ng/L by 4.5
months.
429 had baseline urinary continence status recorded. At 1-2 years
and 2-3 years after focal-HIFU, pad-free status was available in 314
and 247, at baseline and follow-up; 305 (97%) and 241 (98%) were
pad-free (0 pads), respectively. At 1-2 years and 2-3 years after focal-
HIFU, continence status was available in 251 and 195, at baseline and
follow-up; 209 (83%) and 156 (80%) were pad-free, leak-free conti-
nent, respectively.
425 had baseline erectile function recorded. At 1-2 years and 2-3
years, erectile function status was available in 165 and 101, at
baseline and follow-up; 138 (84%) and 87 (86%) maintained erectile
function at 1-2 and 2-3 years following focal-HIFU, respectively. Two
(0.8%) developed a recto-urethral stula of which one healed with
urinary diversion alone and the second required operative
reconstruction.
Of 222 patients that underwent post-operative biopsies, 29 were
found to have in-eld recurrence, 16 out-of-eld de novo disease or
progression and 11 had both. 122 (20%) had a further focal-HIFU
treatment, whilst 44 (7%) transitioned to radical whole-gland therapy
(1% prostatectomy; 6% radiotherapy) whilst 7 (1%) required systemic
hormones alone.
Eight died during follow-up, however, none from prostate cancer.
The metastasis-free survival and overall survival (95%CI) at 5 years
were 97% (95-98) and 99% (97-99), respectively.
CONCLUSIONS: Focal HIFU has acceptable rates of cancer
control with a low genito-urinary side-effect prole in the medium- term
and across a number of centres. It is a low cost, ambulatory and
repeatable procedrre that is minimallyinvasive.
Source of Funding: Sonacare Inc.
MP18-09
WHEN IS TUMOUR VOLUME AN EXCLUSION CRITERIA FOR
FOCAL THERAPY? RESULTS FROM A RADICAL
PROSTATECTOMY SERIES
Nicola Fossati, Giorgio Gandaglia, Nazareno Suardi*,
Umberto Capitanio, Paolo DellOglio, Emanuele Zaffuto, Vito Cucchiara,
Alessandro Larcher, Armando Stabile, Elena Farina, Andrea Salonia,
Francesco Montorsi, Alberto Briganti, Milan, Italy
INTRODUCTION AND OBJECTIVES: While it has been agreed
that the candidate for focal therapy (FT) is a men with low- to inter-
mediate-risk disease, a recent consensus meeting did not agree on a
maximum tumour volume (TV) beyond which FT is deemed not suitable.
However, such lack of consensus may potentially harm a signicant
proportion of men who could still receive FT despite high TV. We hy-
pothesized that TV may differently impacts oncologic outcomes ac-
cording to tumour characteristics
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016 THE JOURNAL OF UROLOGY
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