Oncological outcomes of 356 patients undergoing salvage focal ablative HIFU or cryotherapy following radiation failure

Introduction:
Patients that have previously failed radiotherapy for prostate cancer is usually limited to systemic
therapy due to morbidity from salvage prostatectomy. We reviewed the outcomes following focal
salvage ablative therapy with HIFU or cryotherapy within the UK’s HEAT and ICE registries.

Methods:
356 consecutive patients underwent focal ablative treatment after initial radiation treatment failure
(28/1/2004-1/10/2019, 194 (54.5%) underwent HIFU (posterior recurrence) and 162 (45.5%)
underwent cryotherapy (mostly anterior or T3b). Primary outcome was failure-free survival (FFS)
defined as no systemic therapy, whole-gland treatment, metastases or prostate cancer-specific
death. Secondary outcomes were adverse events and overall survival.

Results:
Median (IQR) age was 69years (65-73) and PSA (IQR) was 4.0ng/ml (1-7-7.2). Overall median (IQR)
follow-up was 41.3 months (21.4-58.5). Quadrant ablation was performed in 128 (36.0%), hemiablation
performed in 64 (18.0%), hockey-stick in 5 (1.4%) and 159 (43.8%) had unknown ablative
patterns. Due to histological or MRI proven recurrence/residual disease, 31 (8.7%) underwent
further focal salvage re-treatment.

FFS (95%CI) at 3 and 6 years were 81% (76-87%) and 75% (68-83%) respectively (figure 1a). Median
(IQR) time to failure was 15.5 months (19.7). Overall survival (95%CI) at 3 and 6 years were 97% (95-
100%) and 88% (81-96%) respectively (figure1b). Prostate-specific mortality was 2.8%. Overall 1
(0.3%) patients were managed for fistula formation, 16 (4.5%) were treated for UTIs.

Conclusion:
Salvage focal ablative therapy for radio-recurrent prostate cancer is safe and provides good short to
medium-term oncological control. The FORECAST study is awaited to further determine oncological
outcomes in this cohort.

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