Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort

Louise Dickinson; Manit Arya; Naveed Afzal; Paul Cathcart; Susan C. Charman; Andrew Cornaby; Richard G. Hindley; Henry Lewi; Neil McCartan; Caroline M. Moore; Senthil Nathan; Chris Ogden; Rajendra A Persad; Jan van der Meulen; Shraddha Weir; Mark Emberton; Hashim U. Ahmed

doi:10.1016/j.eururo.2016.02.054

Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort

Louise Dickinson, Manit Arya, Naveed Afzal, Paul Cathcart, Susan C. Charman, Andrew Cornaby, Richard G. Hindley, Henry Lewi, Neil McCartan, Caroline M. Moore, Senthil Nathan, Chris Ogden, Rajendra A Persad, Jan van der Meulen, Shraddha Weir, Mark Emberton, Hashim U. Ahmed

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

58 Citations (Scopus)

Abstract

Background

High-intensity focused ultrasound (HIFU) is a minimally-invasive treatment for nonmetastatic prostate cancer.

Objective

To report medium-term outcomes in men receiving primary whole-gland HIFU from a national multi-centre registry cohort.

Design, setting, and participants

Five-hundred and sixty-nine patients at eight hospitals were entered into an academic registry.

Intervention

Whole-gland HIFU (Sonablate 500) for primary nonmetastatic prostate cancer. Redo-HIFU was permitted as part of the intervention.

Outcome measurements and statistical analysis

Our primary failure-free survival outcome incorporated no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included adverse events and genitourinary function.

Results and limitations

Mean age was 65 yr (47–87 yr). Median prostate-specific antigen was 7.0 ng/ml (interquartile range 4.4–10.2). National Comprehensive Cancer Network low-, intermediate-, and high-risk disease was 161 (28%), 321 (56%), and 81 (14%), respectively. One hundred and sixty three of 569 (29%) required a total of 185 redo-HIFU procedures. Median follow-up was 46 (interquartile range 23–61) mo. Failure-free survival at 5 yr after first HIFU was 70% (95% confidence interval [CI]: 64–74). This was 87% (95% CI: 78–93), 63% (95% CI: 56–70), and 58% (95% CI: 32–77) for National Comprehensive Cancer Network low-, intermediate-, and high-risk groups, respectively. Fifty eight of 754 (7.7%) had one urinary tract infection, 22/574 (2.9%) a recurrent urinary tract infection, 22/754 (3%) epididymo-orchitis, 227/754 (30%) endoscopic interventions, 1/754 (0.13%) recto-urethral fistula, and 1/754 (0.13%) osteitis pubis. Of 206 known to be pad-free pre-HIFU, 183/206 (88%) remained pad free, and of 236 with good baseline erectile function, 91/236 (39%) maintained good function. The main limitation is lack of long-term data.

Conclusions

Whole-gland HIFU is a repeatable day-case treatment that confers low rates of urinary incontinence. Disease control at a median of just under 5 yr of follow-up demonstrates its potential as a treatment for nonmetastatic prostate cancer. Endoscopic interventions and erectile dysfunction rates are similar to other whole-gland treatments.

Patient summary

In this report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.

Original language	English
Journal	European Urology
Early online date	4 Mar 2016
DOIs	https://doi.org/10.1016/j.eururo.2016.02.054
Publication status	E-pub ahead of print - 4 Mar 2016

Keywords

High-intensity focused ultrasound

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.eururo.2016.02.054

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Dickinson, L., Arya, M., Afzal, N., Cathcart, P., Charman, S. C., Cornaby, A., Hindley, R. G., Lewi, H., McCartan, N., Moore, C. M., Nathan, S., Ogden, C., Persad, R. A., van der Meulen, J., Weir, S., Emberton, M., & Ahmed, H. U. (2016). Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort. European Urology. Advance online publication. https://doi.org/10.1016/j.eururo.2016.02.054

@article{90f337903559412ea6555de53dd3ad2f,

title = "Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort",

abstract = "BackgroundHigh-intensity focused ultrasound (HIFU) is a minimally-invasive treatment for nonmetastatic prostate cancer.ObjectiveTo report medium-term outcomes in men receiving primary whole-gland HIFU from a national multi-centre registry cohort.Design, setting, and participantsFive-hundred and sixty-nine patients at eight hospitals were entered into an academic registry.InterventionWhole-gland HIFU (Sonablate 500) for primary nonmetastatic prostate cancer. Redo-HIFU was permitted as part of the intervention.Outcome measurements and statistical analysisOur primary failure-free survival outcome incorporated no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included adverse events and genitourinary function.Results and limitationsMean age was 65 yr (47–87 yr). Median prostate-specific antigen was 7.0 ng/ml (interquartile range 4.4–10.2). National Comprehensive Cancer Network low-, intermediate-, and high-risk disease was 161 (28%), 321 (56%), and 81 (14%), respectively. One hundred and sixty three of 569 (29%) required a total of 185 redo-HIFU procedures. Median follow-up was 46 (interquartile range 23–61) mo. Failure-free survival at 5 yr after first HIFU was 70% (95% confidence interval [CI]: 64–74). This was 87% (95% CI: 78–93), 63% (95% CI: 56–70), and 58% (95% CI: 32–77) for National Comprehensive Cancer Network low-, intermediate-, and high-risk groups, respectively. Fifty eight of 754 (7.7%) had one urinary tract infection, 22/574 (2.9%) a recurrent urinary tract infection, 22/754 (3%) epididymo-orchitis, 227/754 (30%) endoscopic interventions, 1/754 (0.13%) recto-urethral fistula, and 1/754 (0.13%) osteitis pubis. Of 206 known to be pad-free pre-HIFU, 183/206 (88%) remained pad free, and of 236 with good baseline erectile function, 91/236 (39%) maintained good function. The main limitation is lack of long-term data.ConclusionsWhole-gland HIFU is a repeatable day-case treatment that confers low rates of urinary incontinence. Disease control at a median of just under 5 yr of follow-up demonstrates its potential as a treatment for nonmetastatic prostate cancer. Endoscopic interventions and erectile dysfunction rates are similar to other whole-gland treatments.Patient summaryIn this report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.",

keywords = "High-intensity focused ultrasound",

author = "Louise Dickinson and Manit Arya and Naveed Afzal and Paul Cathcart and Charman, {Susan C.} and Andrew Cornaby and Hindley, {Richard G.} and Henry Lewi and Neil McCartan and Moore, {Caroline M.} and Senthil Nathan and Chris Ogden and Persad, {Rajendra A} and {van der Meulen}, Jan and Shraddha Weir and Mark Emberton and Ahmed, {Hashim U.}",

year = "2016",

month = mar,

day = "4",

doi = "10.1016/j.eururo.2016.02.054",

language = "English",

journal = "European Urology",

issn = "0302-2838",

publisher = "Elsevier B.V.",

}

Dickinson, L, Arya, M, Afzal, N, Cathcart, P, Charman, SC, Cornaby, A, Hindley, RG, Lewi, H, McCartan, N, Moore, CM, Nathan, S, Ogden, C, Persad, RA, van der Meulen, J, Weir, S, Emberton, M & Ahmed, HU 2016, 'Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort', European Urology. https://doi.org/10.1016/j.eururo.2016.02.054

TY - JOUR

T1 - Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort

AU - Dickinson, Louise

AU - Arya, Manit

AU - Afzal, Naveed

AU - Cathcart, Paul

AU - Charman, Susan C.

AU - Cornaby, Andrew

AU - Hindley, Richard G.

AU - Lewi, Henry

AU - McCartan, Neil

AU - Moore, Caroline M.

AU - Nathan, Senthil

AU - Ogden, Chris

AU - Persad, Rajendra A

AU - van der Meulen, Jan

AU - Weir, Shraddha

AU - Emberton, Mark

AU - Ahmed, Hashim U.

PY - 2016/3/4

Y1 - 2016/3/4

N2 - BackgroundHigh-intensity focused ultrasound (HIFU) is a minimally-invasive treatment for nonmetastatic prostate cancer.ObjectiveTo report medium-term outcomes in men receiving primary whole-gland HIFU from a national multi-centre registry cohort.Design, setting, and participantsFive-hundred and sixty-nine patients at eight hospitals were entered into an academic registry.InterventionWhole-gland HIFU (Sonablate 500) for primary nonmetastatic prostate cancer. Redo-HIFU was permitted as part of the intervention.Outcome measurements and statistical analysisOur primary failure-free survival outcome incorporated no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included adverse events and genitourinary function.Results and limitationsMean age was 65 yr (47–87 yr). Median prostate-specific antigen was 7.0 ng/ml (interquartile range 4.4–10.2). National Comprehensive Cancer Network low-, intermediate-, and high-risk disease was 161 (28%), 321 (56%), and 81 (14%), respectively. One hundred and sixty three of 569 (29%) required a total of 185 redo-HIFU procedures. Median follow-up was 46 (interquartile range 23–61) mo. Failure-free survival at 5 yr after first HIFU was 70% (95% confidence interval [CI]: 64–74). This was 87% (95% CI: 78–93), 63% (95% CI: 56–70), and 58% (95% CI: 32–77) for National Comprehensive Cancer Network low-, intermediate-, and high-risk groups, respectively. Fifty eight of 754 (7.7%) had one urinary tract infection, 22/574 (2.9%) a recurrent urinary tract infection, 22/754 (3%) epididymo-orchitis, 227/754 (30%) endoscopic interventions, 1/754 (0.13%) recto-urethral fistula, and 1/754 (0.13%) osteitis pubis. Of 206 known to be pad-free pre-HIFU, 183/206 (88%) remained pad free, and of 236 with good baseline erectile function, 91/236 (39%) maintained good function. The main limitation is lack of long-term data.ConclusionsWhole-gland HIFU is a repeatable day-case treatment that confers low rates of urinary incontinence. Disease control at a median of just under 5 yr of follow-up demonstrates its potential as a treatment for nonmetastatic prostate cancer. Endoscopic interventions and erectile dysfunction rates are similar to other whole-gland treatments.Patient summaryIn this report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.

AB - BackgroundHigh-intensity focused ultrasound (HIFU) is a minimally-invasive treatment for nonmetastatic prostate cancer.ObjectiveTo report medium-term outcomes in men receiving primary whole-gland HIFU from a national multi-centre registry cohort.Design, setting, and participantsFive-hundred and sixty-nine patients at eight hospitals were entered into an academic registry.InterventionWhole-gland HIFU (Sonablate 500) for primary nonmetastatic prostate cancer. Redo-HIFU was permitted as part of the intervention.Outcome measurements and statistical analysisOur primary failure-free survival outcome incorporated no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included adverse events and genitourinary function.Results and limitationsMean age was 65 yr (47–87 yr). Median prostate-specific antigen was 7.0 ng/ml (interquartile range 4.4–10.2). National Comprehensive Cancer Network low-, intermediate-, and high-risk disease was 161 (28%), 321 (56%), and 81 (14%), respectively. One hundred and sixty three of 569 (29%) required a total of 185 redo-HIFU procedures. Median follow-up was 46 (interquartile range 23–61) mo. Failure-free survival at 5 yr after first HIFU was 70% (95% confidence interval [CI]: 64–74). This was 87% (95% CI: 78–93), 63% (95% CI: 56–70), and 58% (95% CI: 32–77) for National Comprehensive Cancer Network low-, intermediate-, and high-risk groups, respectively. Fifty eight of 754 (7.7%) had one urinary tract infection, 22/574 (2.9%) a recurrent urinary tract infection, 22/754 (3%) epididymo-orchitis, 227/754 (30%) endoscopic interventions, 1/754 (0.13%) recto-urethral fistula, and 1/754 (0.13%) osteitis pubis. Of 206 known to be pad-free pre-HIFU, 183/206 (88%) remained pad free, and of 236 with good baseline erectile function, 91/236 (39%) maintained good function. The main limitation is lack of long-term data.ConclusionsWhole-gland HIFU is a repeatable day-case treatment that confers low rates of urinary incontinence. Disease control at a median of just under 5 yr of follow-up demonstrates its potential as a treatment for nonmetastatic prostate cancer. Endoscopic interventions and erectile dysfunction rates are similar to other whole-gland treatments.Patient summaryIn this report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.

KW - High-intensity focused ultrasound

U2 - 10.1016/j.eururo.2016.02.054

DO - 10.1016/j.eururo.2016.02.054

M3 - Article (Academic Journal)

C2 - 26951947

SN - 0302-2838

JO - European Urology

JF - European Urology

ER -

Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort

Abstract

Keywords

UN SDGs

Access to Document

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Fingerprint

Cite this