A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer
Clinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects. To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individ...
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| Veröffentlicht in: | European urology 2018-10, Vol.74 (4), p.422-429 |
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| creator | Guillaumier, Stephanie Peters, Max Arya, Manit Afzal, Naveed Charman, Susan Dudderidge, Tim Hosking-Jervis, Feargus Hindley, Richard G. Lewi, Henry McCartan, Neil Moore, Caroline M. Nigam, Raj Ogden, Chris Persad, Raj Shah, Karishma van der Meulen, Jan Virdi, Jaspal Winkler, Mathias Emberton, Mark Ahmed, Hashim U. |
| description | Clinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects.
To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate.
This was a prospective study of 625 consecutive patients with nonmetastatic clinically significant PCa undergoing focal HIFU therapy (Sonablate) in secondary care centres between January 1, 2006 and December 31, 2015. A minimum of 6-mo follow-up was available for599 patients. Intermediate- or high-risk PCa was found in 505 patients (84%).
Disease was localised using multiparametric magnetic resonance imaging (mpMRI) combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included prostate-specific antigen (PSA) measurement, mpMRI, and biopsies.
The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality.
The median follow-up was 56 mo (interquartile range [IQR] 35–70). The median age was 65 yr (IQR 61–71) and median preoperative PSA was 7.2 ng/ml (IQR 5.2–10.0). FFS was 99% (95% confidence interval [CI] 98–100%) at 1 yr, 92% (95% CI 90–95%) at 3 yr, and 88% (95% 85–91%) at 5 yr. For the whole patient cohort, metastasis-free, cancer-specific, and overall survival at 5 yr was 98% (95% CI 97–99%), 100%, and 99% (95% CI 97–100%), respectively. Among patients who returned validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than 1 pad/d. Limitations include the lack of long-term follow-up.
Focal therapy for select patients with clinically significant nonmetastatic prostate cancer is effective in the medium term and has a low probability of side effects.
In this multicentre study of 625 patients undergoing focal therapy using high-intensity focused ultrasound (HIFU), failure-free survival, metastasis-free survival, cancer-specific survival, and overall survival were 88%, 98%, 100%, and 99%, respectively. Urinary incontinence (any pad use) was 2%. Focal HIFU therapy for patients with clinically significant prostate cancer that has not spread has a low probability of side effects and is effective at 5 yr.
Our study shows that at median follow-up of approximately 5 yr after focal high-intensity focused ultras |
| doi_str_mv | 10.1016/j.eururo.2018.06.006 |
| format | Article |
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To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate.
This was a prospective study of 625 consecutive patients with nonmetastatic clinically significant PCa undergoing focal HIFU therapy (Sonablate) in secondary care centres between January 1, 2006 and December 31, 2015. A minimum of 6-mo follow-up was available for599 patients. Intermediate- or high-risk PCa was found in 505 patients (84%).
Disease was localised using multiparametric magnetic resonance imaging (mpMRI) combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included prostate-specific antigen (PSA) measurement, mpMRI, and biopsies.
The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality.
The median follow-up was 56 mo (interquartile range [IQR] 35–70). The median age was 65 yr (IQR 61–71) and median preoperative PSA was 7.2 ng/ml (IQR 5.2–10.0). FFS was 99% (95% confidence interval [CI] 98–100%) at 1 yr, 92% (95% CI 90–95%) at 3 yr, and 88% (95% 85–91%) at 5 yr. For the whole patient cohort, metastasis-free, cancer-specific, and overall survival at 5 yr was 98% (95% CI 97–99%), 100%, and 99% (95% CI 97–100%), respectively. Among patients who returned validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than 1 pad/d. Limitations include the lack of long-term follow-up.
Focal therapy for select patients with clinically significant nonmetastatic prostate cancer is effective in the medium term and has a low probability of side effects.
In this multicentre study of 625 patients undergoing focal therapy using high-intensity focused ultrasound (HIFU), failure-free survival, metastasis-free survival, cancer-specific survival, and overall survival were 88%, 98%, 100%, and 99%, respectively. Urinary incontinence (any pad use) was 2%. Focal HIFU therapy for patients with clinically significant prostate cancer that has not spread has a low probability of side effects and is effective at 5 yr.
Our study shows that at median follow-up of approximately 5 yr after focal high-intensity focused ultrasound, nine out of ten patients with predominantly intermediate- or high-risk prostate cancer are able to avoid surgery, radiotherapy, and systemic therapy. Prostate cancer–specific survival was 100%. There was a low probability of urinary incontinence (2%), erectile dysfunction (15%), and rectal side effects (rare).</description><identifier>ISSN: 0302-2838</identifier><identifier>EISSN: 1873-7560</identifier><identifier>DOI: 10.1016/j.eururo.2018.06.006</identifier><identifier>PMID: 29960750</identifier><language>eng</language><publisher>Switzerland: Elsevier B.V</publisher><subject>Focal therapy ; High-intensity focused ultrasound ; Multiparametric magnetic resonance imaging ; Targeted biopsy ; Transperineal biopsy</subject><ispartof>European urology, 2018-10, Vol.74 (4), p.422-429</ispartof><rights>2018 The Authors</rights><rights>Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.</rights><rights>2018 The Authors 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c580t-179c68b9219fd80fbd9224872356d713365e6fec82e592df236a6c1aef866bf53</citedby><cites>FETCH-LOGICAL-c580t-179c68b9219fd80fbd9224872356d713365e6fec82e592df236a6c1aef866bf53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0302283818304317$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29960750$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guillaumier, Stephanie</creatorcontrib><creatorcontrib>Peters, Max</creatorcontrib><creatorcontrib>Arya, Manit</creatorcontrib><creatorcontrib>Afzal, Naveed</creatorcontrib><creatorcontrib>Charman, Susan</creatorcontrib><creatorcontrib>Dudderidge, Tim</creatorcontrib><creatorcontrib>Hosking-Jervis, Feargus</creatorcontrib><creatorcontrib>Hindley, Richard G.</creatorcontrib><creatorcontrib>Lewi, Henry</creatorcontrib><creatorcontrib>McCartan, Neil</creatorcontrib><creatorcontrib>Moore, Caroline M.</creatorcontrib><creatorcontrib>Nigam, Raj</creatorcontrib><creatorcontrib>Ogden, Chris</creatorcontrib><creatorcontrib>Persad, Raj</creatorcontrib><creatorcontrib>Shah, Karishma</creatorcontrib><creatorcontrib>van der Meulen, Jan</creatorcontrib><creatorcontrib>Virdi, Jaspal</creatorcontrib><creatorcontrib>Winkler, Mathias</creatorcontrib><creatorcontrib>Emberton, Mark</creatorcontrib><creatorcontrib>Ahmed, Hashim U.</creatorcontrib><title>A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer</title><title>European urology</title><addtitle>Eur Urol</addtitle><description>Clinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects.
To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate.
This was a prospective study of 625 consecutive patients with nonmetastatic clinically significant PCa undergoing focal HIFU therapy (Sonablate) in secondary care centres between January 1, 2006 and December 31, 2015. A minimum of 6-mo follow-up was available for599 patients. Intermediate- or high-risk PCa was found in 505 patients (84%).
Disease was localised using multiparametric magnetic resonance imaging (mpMRI) combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included prostate-specific antigen (PSA) measurement, mpMRI, and biopsies.
The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality.
The median follow-up was 56 mo (interquartile range [IQR] 35–70). The median age was 65 yr (IQR 61–71) and median preoperative PSA was 7.2 ng/ml (IQR 5.2–10.0). FFS was 99% (95% confidence interval [CI] 98–100%) at 1 yr, 92% (95% CI 90–95%) at 3 yr, and 88% (95% 85–91%) at 5 yr. For the whole patient cohort, metastasis-free, cancer-specific, and overall survival at 5 yr was 98% (95% CI 97–99%), 100%, and 99% (95% CI 97–100%), respectively. Among patients who returned validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than 1 pad/d. Limitations include the lack of long-term follow-up.
Focal therapy for select patients with clinically significant nonmetastatic prostate cancer is effective in the medium term and has a low probability of side effects.
In this multicentre study of 625 patients undergoing focal therapy using high-intensity focused ultrasound (HIFU), failure-free survival, metastasis-free survival, cancer-specific survival, and overall survival were 88%, 98%, 100%, and 99%, respectively. Urinary incontinence (any pad use) was 2%. Focal HIFU therapy for patients with clinically significant prostate cancer that has not spread has a low probability of side effects and is effective at 5 yr.
Our study shows that at median follow-up of approximately 5 yr after focal high-intensity focused ultrasound, nine out of ten patients with predominantly intermediate- or high-risk prostate cancer are able to avoid surgery, radiotherapy, and systemic therapy. Prostate cancer–specific survival was 100%. There was a low probability of urinary incontinence (2%), erectile dysfunction (15%), and rectal side effects (rare).</description><subject>Focal therapy</subject><subject>High-intensity focused ultrasound</subject><subject>Multiparametric magnetic resonance imaging</subject><subject>Targeted biopsy</subject><subject>Transperineal biopsy</subject><issn>0302-2838</issn><issn>1873-7560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9UU1v1DAQjRCILoV_gJCPXBL8sXacC1K1ooBUKFKXs-V1xluvnHixnaKc-Os4bClw4eSx3ps38-ZV1UuCG4KJeHNoYIpTDA3FRDZYNBiLR9WKyJbVLRf4cbXCDNOaSibPqmcpHTDGjHfsaXVGu07gluNV9eMCfZp8dgbGHAHd5KmfUbCI1zPoiK6nbMIACV0G78N3N-5LZbRH21uI-jgjN6JtBJ0XZOPd6AroZ3Tj9qOz5TNm9DmMA2SdcmEZ9CWGpQK00aOB-Lx6YrVP8OL-Pa--Xr7bbj7UV9fvP24urmrDJc41aTsj5K6jpLO9xHbXd5SuZUsZF31LGBMchAUjKfCO9pYyoYUhGqwUYmc5O6_ennSP026A_pdd7dUxukHHWQXt1L_I6G7VPtwpQbjgLSsCr-8FYvg2QcpqcMmA93qEMCVFsWAt4WuxUNcnqileUwT7MIZgtWSnDuqUnVqyU1iokl1pe_X3ig9Nv8P64wHKoe4cRJWMg3LF3kUwWfXB_X_CT_rkr-Y</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Guillaumier, Stephanie</creator><creator>Peters, Max</creator><creator>Arya, Manit</creator><creator>Afzal, Naveed</creator><creator>Charman, Susan</creator><creator>Dudderidge, Tim</creator><creator>Hosking-Jervis, Feargus</creator><creator>Hindley, Richard G.</creator><creator>Lewi, Henry</creator><creator>McCartan, Neil</creator><creator>Moore, Caroline M.</creator><creator>Nigam, Raj</creator><creator>Ogden, Chris</creator><creator>Persad, Raj</creator><creator>Shah, Karishma</creator><creator>van der Meulen, Jan</creator><creator>Virdi, Jaspal</creator><creator>Winkler, Mathias</creator><creator>Emberton, Mark</creator><creator>Ahmed, Hashim U.</creator><general>Elsevier B.V</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201810</creationdate><title>A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer</title><author>Guillaumier, Stephanie ; Peters, Max ; Arya, Manit ; Afzal, Naveed ; Charman, Susan ; Dudderidge, Tim ; Hosking-Jervis, Feargus ; Hindley, Richard G. ; Lewi, Henry ; McCartan, Neil ; Moore, Caroline M. ; Nigam, Raj ; Ogden, Chris ; Persad, Raj ; Shah, Karishma ; van der Meulen, Jan ; Virdi, Jaspal ; Winkler, Mathias ; Emberton, Mark ; Ahmed, Hashim U.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c580t-179c68b9219fd80fbd9224872356d713365e6fec82e592df236a6c1aef866bf53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Focal therapy</topic><topic>High-intensity focused ultrasound</topic><topic>Multiparametric magnetic resonance imaging</topic><topic>Targeted biopsy</topic><topic>Transperineal biopsy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guillaumier, Stephanie</creatorcontrib><creatorcontrib>Peters, Max</creatorcontrib><creatorcontrib>Arya, Manit</creatorcontrib><creatorcontrib>Afzal, Naveed</creatorcontrib><creatorcontrib>Charman, Susan</creatorcontrib><creatorcontrib>Dudderidge, Tim</creatorcontrib><creatorcontrib>Hosking-Jervis, Feargus</creatorcontrib><creatorcontrib>Hindley, Richard G.</creatorcontrib><creatorcontrib>Lewi, Henry</creatorcontrib><creatorcontrib>McCartan, Neil</creatorcontrib><creatorcontrib>Moore, Caroline M.</creatorcontrib><creatorcontrib>Nigam, Raj</creatorcontrib><creatorcontrib>Ogden, Chris</creatorcontrib><creatorcontrib>Persad, Raj</creatorcontrib><creatorcontrib>Shah, Karishma</creatorcontrib><creatorcontrib>van der Meulen, Jan</creatorcontrib><creatorcontrib>Virdi, Jaspal</creatorcontrib><creatorcontrib>Winkler, Mathias</creatorcontrib><creatorcontrib>Emberton, Mark</creatorcontrib><creatorcontrib>Ahmed, Hashim U.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guillaumier, Stephanie</au><au>Peters, Max</au><au>Arya, Manit</au><au>Afzal, Naveed</au><au>Charman, Susan</au><au>Dudderidge, Tim</au><au>Hosking-Jervis, Feargus</au><au>Hindley, Richard G.</au><au>Lewi, Henry</au><au>McCartan, Neil</au><au>Moore, Caroline M.</au><au>Nigam, Raj</au><au>Ogden, Chris</au><au>Persad, Raj</au><au>Shah, Karishma</au><au>van der Meulen, Jan</au><au>Virdi, Jaspal</au><au>Winkler, Mathias</au><au>Emberton, Mark</au><au>Ahmed, Hashim U.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer</atitle><jtitle>European urology</jtitle><addtitle>Eur Urol</addtitle><date>2018-10</date><risdate>2018</risdate><volume>74</volume><issue>4</issue><spage>422</spage><epage>429</epage><pages>422-429</pages><issn>0302-2838</issn><eissn>1873-7560</eissn><abstract>Clinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects.
To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate.
This was a prospective study of 625 consecutive patients with nonmetastatic clinically significant PCa undergoing focal HIFU therapy (Sonablate) in secondary care centres between January 1, 2006 and December 31, 2015. A minimum of 6-mo follow-up was available for599 patients. Intermediate- or high-risk PCa was found in 505 patients (84%).
Disease was localised using multiparametric magnetic resonance imaging (mpMRI) combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included prostate-specific antigen (PSA) measurement, mpMRI, and biopsies.
The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality.
The median follow-up was 56 mo (interquartile range [IQR] 35–70). The median age was 65 yr (IQR 61–71) and median preoperative PSA was 7.2 ng/ml (IQR 5.2–10.0). FFS was 99% (95% confidence interval [CI] 98–100%) at 1 yr, 92% (95% CI 90–95%) at 3 yr, and 88% (95% 85–91%) at 5 yr. For the whole patient cohort, metastasis-free, cancer-specific, and overall survival at 5 yr was 98% (95% CI 97–99%), 100%, and 99% (95% CI 97–100%), respectively. Among patients who returned validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than 1 pad/d. Limitations include the lack of long-term follow-up.
Focal therapy for select patients with clinically significant nonmetastatic prostate cancer is effective in the medium term and has a low probability of side effects.
In this multicentre study of 625 patients undergoing focal therapy using high-intensity focused ultrasound (HIFU), failure-free survival, metastasis-free survival, cancer-specific survival, and overall survival were 88%, 98%, 100%, and 99%, respectively. Urinary incontinence (any pad use) was 2%. Focal HIFU therapy for patients with clinically significant prostate cancer that has not spread has a low probability of side effects and is effective at 5 yr.
Our study shows that at median follow-up of approximately 5 yr after focal high-intensity focused ultrasound, nine out of ten patients with predominantly intermediate- or high-risk prostate cancer are able to avoid surgery, radiotherapy, and systemic therapy. Prostate cancer–specific survival was 100%. There was a low probability of urinary incontinence (2%), erectile dysfunction (15%), and rectal side effects (rare).</abstract><cop>Switzerland</cop><pub>Elsevier B.V</pub><pmid>29960750</pmid><doi>10.1016/j.eururo.2018.06.006</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | European urology, 2018-10, Vol.74 (4), p.422-429 |
| issn | 0302-2838 1873-7560 |
| language | eng |
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| source | Elsevier ScienceDirect Journals |
| subjects | Focal therapy High-intensity focused ultrasound Multiparametric magnetic resonance imaging Targeted biopsy Transperineal biopsy |
| title | A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer |
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