Authors: Kiki Mistry, Utsav Reddy, Basingstoke, United Kingdom, Simon Bott, Surrey, United Kingdom, Amr Emara, Richard Hindley*, Basingstoke, United Kingdom
Introduction: Focal therapy using High Intensity Focused Ultrasound (HIFU) in the treatment of non-metastatic prostate cancer has been shown to confer a low risk of genitourinary side-effects with encouraging early disease control. We present our single centre experience over a 7 year period (2009-2016) of 164 cases. Here we report on medium term functional and oncological outcomes in this group of patients.
Methods: 164 patients with (T1c-T3a) localised prostate cancer were treated with focal-HIFU. Multi-parametric MRI followed by transperineal mapping biopsies and/or MR-targeted biopsies was used as the standard diagnostic tool. Focal-HIFU was carried out according to disease location and Surgeon planning but usually involved a hemi or quadrant ablation. Patient follow up included regular PSA, MRI and further prostate biopsies if indicated.
Results: 32 (20%), 117 (71%) and 15 (9%) had low, intermediate and high-risk disease, respectively. Median PSA at diagnosis was 7 (range 2.6-21.4). Median follow-up was 50 (range 2-78) months.
100% of patients who were pad free prior to treatment maintained pad free status by 3 months post procedure while 82% of patients who was had satisfactory pre-operative erection maintained their potency post-operatively. There were no major complications and 1 developed a stricture which required intervention.
Median PSA nadir was 1.2ng /L by 4.5 months. 7 patients had a further focal-HIFU treatment, whilst 5 had radical prostatectomy and 1 had Radiotherapy. 1 patient underwent cryotherapy and 1 HIFU for contralateral disease. 1 patient required systemic hormones for metastatic disease. Metastasis-free survival and overall cancer specific survival at 5 years was 99.4% and 100% respectively.
Conclusions: Our single centre focal HIFU experience supports the place for a focal ablative therapy in the management of prostate cancer in carefully selected cases. We have demonstrated good oncological results with minimal morbidity and a favourable side-effect profile.