Focal HIFU: Higher recurrence rate in treatment of anterior compared to posterior lesions in prostate cancer

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... This rough classification has been proposed by an international FT expert group as an approach to focal ablation [12], although comparative efficacy studies are missing. Not only clinical experience, but also scientific evidence arises, demonstrating that energy modalities have limitations depending on the treated prostate zone: HIFU ablation seems to treat posterior lesions with improved efficacy compared with anterior lesions [30]. A recent report showed that this approach has already been implemented in clinical routine where decisions between focal HIFU and cryotherapy are made depending on zonal location [31]. ...
Background Focal therapy (FT) with its favorable side-effect profile represents an option between active surveillance and traditional whole-gland treatment in localized prostate cancer (PCa). Consensus statements recommend eligibility criteria based on magnetic resonance imaging (MRI)-targeted and systematic combination biopsy. Objective To estimate the future potential of FT by analyzing the number of men eligible for FT among all men with biopsy-proven PCa and to judge the potential of different energy sources. Design, setting, and participants Consensus criteria on FT were analyzed. Patients with biopsy-proven PCa from six tertiary referral hospitals and one outpatient practice in Germany had received a software-based combination biopsy. Men with Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesions based on PI-RADS v2 were included. Outcome measurements and statistical analysis Patients were analyzed for potential treatment by FT and hemiablation. MRI lesions were mapped according to prostatic zones. Results and limitations In total, 2371 patients were analyzed. According to consensus criteria (biopsy-proven unifocal lesion of International Society of Urological Pathology [ISUP] grade group ≤2, prostate-specific antigen [PSA] ≤15 ng/mL, and life expectancy >10 yr), 303 patients (12.8%; ISUP 1: n = 148 [6.2%]; ISUP 2: n = 155 [6.5%]) were potential candidates for FT. A maximum PSA level of <10 ng/mL would exclude further 60 (2.5%) of these men. The eligibility for hemiablation is slightly higher (16.2%). Unifocal lesions (n = 288) were equally distributed within the prostate (anteriorly [31%], apically [29%], and dorsally [36%]). Conclusions With adherence to consensus statements, only a minority of PCa patients present as potential candidates for FT. Distribution of tumor localization suggests the need for different energy modalities to warrant an optimal FT treatment. Patient summary We analyzed how many men who receive a magnetic resonance imaging–targeted and systematic prostate biopsy are candidates for the experimental focal therapy of the prostate. When following expert recommendations, only a small number of men are potential candidates for this alternative treatment.
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