MP62-03 HIGH-INTENSITY FOCUSSED ULTRASOUND IN THE TREATMENT OF LOCALISED PROSTATE CANCER: FOCAL SALVAGE TRANSITION RATES

Abstract

INTRODUCTION AND OBJECTIVES: Focal therapy has shown encouraging low rates of genitourinary side-effects in the treatment of localised prostate cancer. As biochemical failure is difficult to define discussion has centred on rates of transition to whole-gland local therapy and need for systemic therapy. We report on our registry experience of over 1,000 men treated with transrectal HIFU. METHODS: Our independent academic HIFU registry incorporates a total of 830 patients with low, intermediate and high risk, stage T2a-T3aN0M0 prostate adenocarcinoma treated between 2004 and 2012 in a primary setting. Of these, 509 had focal HIFU treatment (Sonablate 500); 313 had whole-gland treatment. We defined our composite failure as need for whole-gland therapy and/or systemic therapy. RESULTS: Of 509 men undergoing focal HIFU therapy, 84 required redo-HIFU (17%). None of the patients in this group went on to have radical prostatectomy. 1% (5/509) had salvage radiotherapy and <0.5% (1/509) had salvage chemotherapy due to lung metastases following a renal primary. 1% (5/509) were subsequently treated with androgen deprivation therapy alone. In the same period, 313 patients had whole-gland HIFU treatment. Of these, 40% (124/313) had redo-HIFU and 5% (15/313) had androgen deprivation for treatment failure. 6% (18/313) underwent salvage radiotherapy and <1% (2/313) were further treated with salvage radical prostatectomy. <0.5% (1/313) had salvage chemotherapy and <0.5% (1/313) had cryotherapy. CONCLUSIONS: Focal therapy demonstrates reassuringly low short to medium term rates of transition to whole-gland local therapy or systemic therapy in 11%. Longer follow-up will determine rates of metastases and mortality.