MP73-02 FOCAL THERAPY - 7 YEARS EXPERIENCE WITH FOCAL HIGH INTENSITY FOCUSED ULTRASOUND IN 164 PATIENTS WITH PROSTATE CANCER: SINGLE CENTER RESULTS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP73-02 FOCAL THERAPY - 7 YEARS EXPERIENCE WITH FOCAL HIGH INTENSITY FOCUSED ULTRASOUND IN 164 PATIENTS WITH PROSTATE CANCER: SINGLE CENTER RESULTS Yamini Nagaraj, Fabian Falkenbach, Valia Veleva, Randi Marisa Pose, Jonas Ekrutt, Raisa Abrams-Pompe, Jaideep Ratkal, Pierre Tennstedt, Derya Tilki, Hans Heinzer, Markus Graefen, and Georg Salomon Yamini NagarajYamini Nagaraj More articles by this author , Fabian FalkenbachFabian Falkenbach More articles by this author , Valia VelevaValia Veleva More articles by this author , Randi Marisa PoseRandi Marisa Pose More articles by this author , Jonas EkruttJonas Ekrutt More articles by this author , Raisa Abrams-PompeRaisa Abrams-Pompe More articles by this author , Jaideep RatkalJaideep Ratkal More articles by this author , Pierre TennstedtPierre Tennstedt More articles by this author , Derya TilkiDerya Tilki More articles by this author , Hans HeinzerHans Heinzer More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Georg SalomonGeorg Salomon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy aims to selectively ablate tumor lesions and preserve prostate tissue, thus minimizing side effect whilst providing oncological control. The experience of the first 2 years lead to improved diagnostic work up prior to HIFU with better patient selection and less tumor recurrence in the following 5 years. The strong recommendation of control biopsy in the follow up, lead to a reliable and early selection of patients requiring salvage therapy and thus improving oncological results. METHODS: This is a prospective evaluation of 164 patients undergoing focal high intensity focused ultrasound (HIFU) in our institution from July 2015 till June 2022. Patients were required to have a unilateral Gleason score (GS) ≤7, stage T1 or T2 and a PSA level of≤15 ng/ml. Tumor localization was done using multiparametric MRI followed by mainly transrectal targeted and systematic biopsies of any lesion PI-RADS≥3. Systematic biopsy was recommended 1 year after HIFU with PSA levels every 3 months. An MRI was scheduled at 3 years post HIFU. In the control biopsy significant cancer recurrence was defined as >3mm GS 3+3, >3 positive cores or any GS≥3+4; these patients were offered further treatment; either a repeat HIFU, radical prostatectomy (RP) or radiation therapy (RT). Urinary and erectile function were assessed using validated questionnaires. RESULTS: Median PSA prior to HIFU was 6 ng/ml, the median follow-up was 61 months. 38% of the patients had low, 60% intermediate and 2% high risk disease. Median PSA level 2 years post HIFU was 1.9 ng/ml. Of the 119 control biopsies 50% had no evidence of tumor, 36% had insignificant tumor evidence and 14 % showed evidence of significant prostate cancer according to the above defined criteria. Significant infield recurrence occurred in 6 patients (4%) and significant outfield recurrence was seen in 10 patients (6%). 5 patients received a repeat HIFU, 4 patients a RT and 7 had a RP. There were no cases of distant metastasis, no need for palliative antiandrogen therapy (ADT) and no major complications. Urinary continence and erectile function were preserved in 99.5% and 85% respectively. CONCLUSIONS: At 7 years, HIFU therapy showed efficient oncological control rates with a radical treatment free survival rate of 93%. Significant infield recurrence was seen in 4% and significant outfield recurrence in 6% of patients. There was no distant metastasis and no need for palliative ADT. HIFU is associated with excellent preservation of continence and erectile function with very low morbidity. Source of Funding: Non funded © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1034 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yamini Nagaraj More articles by this author Fabian Falkenbach More articles by this author Valia Veleva More articles by this author Randi Marisa Pose More articles by this author Jonas Ekrutt More articles by this author Raisa Abrams-Pompe More articles by this author Jaideep Ratkal More articles by this author Pierre Tennstedt More articles by this author Derya Tilki More articles by this author Hans Heinzer More articles by this author Markus Graefen More articles by this author Georg Salomon More articles by this author Expand All Advertisement PDF downloadLoading ...