Abstract
ObjectiveTo compare cancer control in anterior compared to posterior prostate cancer lesions treated with a focal HIFU therapy approach.Materials and methodsIn a prospectively maintained national database, 598 patients underwent focal HIFU (Sonablate®500) (March/2007–November/2016). Follow-up occurred with 3-monthly clinic visits and PSA testing in the first year with PSA, every 6–12 months with mpMRI with biopsy for MRI-suspicion of recurrence. Treatment failure was any secondary treatment (ADT/chemotherapy, cryotherapy, EBRT, RRP, or re-HIFU), tumour recurrence with Gleason ≥ 3 + 4 on prostate biopsy without further treatment or metastases/prostate cancer-related mortality. Cases with anterior cancer were compared to those with posterior disease.Results267 patients were analysed following eligibility criteria. 45 had an anterior focal-HIFU and 222 had a posterior focal-HIFU. Median age was 64 years and 66 years, respectively, with similar PSA level of 7.5 ng/ml and 6.92 ng/ml. 84% and 82%, respectively, had Gleason 3 + 4, 16% in both groups had Gleason 4 + 3, 0% and 2% had Gleason 4 + 4. Prostate volume was similar (33 ml vs. 36 ml, p = 0.315); median number of positive cores in biopsies was different in anterior and posterior tumours (7 vs. 5, p = 0.009), while medium cancer core length, and maximal cancer percentage of core were comparable. 17/45 (37.8%) anterior focal-HIFU patients compared to 45/222 (20.3%) posterior focal-HIFU patients required further treatment (p = 0.019).ConclusionTreating anterior prostate cancer lesions with focal HIFU may be less effective compared to posterior tumours.
Highlights
Since high-intensity focused ultrasound (HIFU) was first started for the treatment of prostate cancer [1], treatment parameters have been refined from ablating the whole prostate gland to hemi-gland ablation, quadrant ablation and so-called ultra-focal ablation of cancerous areas [2]
We aimed to compare cancer control in anterior compared to posterior prostate cancer lesions treated with a focal HIFU therapy approach
We have previously reported on the high negative predictive value of mpMRI in the post-focal HIFU setting for clinically significant prostate cancer [6]
Summary
Since high-intensity focused ultrasound (HIFU) was first started for the treatment of prostate cancer [1], treatment parameters have been refined from ablating the whole prostate gland to hemi-gland ablation, quadrant ablation and so-called ultra-focal ablation of cancerous areas [2]. The energy source for HIFU is usually placed in the patient’s rectum, with ultrasound waves having to traverse a number of tissue planes. There can be loss of energy by passing multiple tissue planes and large volumes of tissue between source and prostate tumour. There has been some concern as to whether HIFU is able to confer similar cancer control rates for treating anterior prostate tumours. We aimed to compare cancer control in anterior compared to posterior prostate cancer lesions treated with a focal HIFU therapy approach
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