Focal High Intensity Focused Ultrasound of Unilateral Localized Prostate Cancer: A Prospective Multicentric Hemiablation Study of 111 Patients

Rischmann, P.; Gelet, A.; Riche, Benjamin; Villers, Arnauld; Pasticier, G.; Bondil, P.; Jung, Jean; Bugel, H.; Petit, J; Toledano, H.; Mallick, S.; Rouvière, Olivier; Rabilloud, Muriel; Tonoli-Catez, Hélène; Crouzet, Sébastien

doi:10.1016/j.eururo.2016.09.039

Cited by 146 publications

(106 citation statements)

References 25 publications

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“…In both study groups, PSA levels continued to decrease significantly relative to the 3-month values. This contrasts with most HG HIFU and cryotherapy studies where PSA levels are no longer reduced 3 months after treatment [24][25][26][27][28]. The divergent behaviour in PSA kinetics between temperature-based ablative therapies and PB may be explained by their mechanism of action.…”

Section: Disease Control Beyond 24 Monthsmentioning

confidence: 77%

Hemi‐ablative low‐dose‐rate prostate brachytherapy for unilateral localised prostate cancer

Langley¹,

Uribe²,

Uribe-Lewis³

et al. 2019

BJU International

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Objectives To report clinical outcomes of the Hemi‐Ablative Prostate Brachytherapy (HAPpy) trial evaluating treatment‐related toxicity and effectiveness of hemi‐gland (HG) low‐dose‐rate (LDR) prostate brachytherapy as a focal approach to control unilateral localised prostate cancer. Patients and Methods Single institution phase IIS pilot study of patients treated with focal 4D Brachytherapy™ (BXTAccelyon, Burnham, Buckinghamshire, UK). The primary outcome was patient‐reported toxicity 24 months after implant. The secondary outcome was assessment of disease control. Outcomes in HG patients were compared to whole‐gland (WG) controls obtained from our prospective cohort registry by negative binomial and linear regression models. Results Pre‐treatment demography was similar between the 30 HG patients and 362 WG controls. Post‐implant dosimetry was similar for the prostate gland target volumes and significantly reduced for the urethra and bowel in HG patients relative to WG controls, but this did not translate into a difference in post‐implant mean symptom scores between the two groups. Nevertheless, the change in score from baseline indicated that the impact on pre‐treatment symptom status was less after HG implants. Only HG patients showed a return to baseline urinary scores as early as 12 months. Sexual potency was conserved in 73% and 67% of HG and WG patients, respectively (P = 0.84). Post‐implant prostate‐specific antigen (PSA) kinetics revealed that baseline PSA was reduced at 24 months by 78% and 88% in HG and WG patients, respectively (P < 0.05). Treatment relapse occurred in one (3%) HG patient 55 months after implant and in nine (3%) WG patients at 32–67 months after implant. Conclusion This pilot study suggests that treatment‐related toxicity and biochemical outcomes after HG implants are broadly similar to those observed with WG treatment despite the lower dose delivered by HG implants.

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Section: Disease Control Beyond 24 Monthsmentioning

confidence: 77%

Hemi‐ablative low‐dose‐rate prostate brachytherapy for unilateral localised prostate cancer

Langley¹,

Uribe²,

Uribe-Lewis³

et al. 2019

BJU International

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“…For the purposes of focal therapy, underestimation of true tumour extent is a critical shortcoming that decreases treatment effectiveness. Studies with mandated whole-gland biopsy at 1 year following HGA report between 10% and 20% cancer detection rate contralateral to the treated half of the prostate [24,25]. The rates of contralateral disease undetected on biopsy in these studies is also likely significant based on emerging analyses, which can lead to subsequent insidious progression to higher-risk disease [9][10][11].…”

Section: Discussionmentioning

confidence: 97%

Using spatial tracking with magnetic resonance imaging/ultrasound‐guided biopsy to identify unilateral prostate cancer

et al. 2019

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Objectives To create reliable predictive metrics of unilateral disease using spatial tracking from a fusion device, thereby improving patient selection for hemi‐gland ablation of prostate cancer. Patients and Methods We identified patients who received magnetic resonance imaging (MRI)/ultrasound‐guided biopsy and radical prostatectomy at a single institution between 2011 and 2018. In addition to standard clinical features, we extracted quantitative features related to biopsy core and MRI target locations predictive of tumour unilaterality. Classification and Regression Tree (CART) analysis was used to create a decision tree (DT) for identifying cancer laterality. We evaluated concordance of model‐determined laterality with final surgical pathology. Results A total of 173 patients were identified with biopsy coordinates and surgical pathology available. Based on CART analysis, in addition to biopsy‐ and MRI‐confirmed disease unilaterality, patients should be further screened for cancer detected within 7 mm of midline in a 40 mL prostate, which equates to the central third of any‐sized prostate by radius. The area under the curve for this DT was 0.82. Standard diagnostics and the DT correctly identified disease laterality in 73% and 80% of patients, respectively (P = 0.13). Of the patients identified as unilateral by standard diagnostics, 47% had undetected contralateral disease or were otherwise incorrectly identified. This error rate was reduced to 17% (P = 0.01) with the DT. Conclusion Using spatial tracking from fusion devices, a DT was more reliable for identifying laterality of prostate cancer compared to standard diagnostics. Patients with cancer detected within the central third of the prostate by radius are poor hemi‐gland ablation candidates due to the risk of midline extension of tumour.

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“…A major challenge of focal therapy for prostate cancer is the uncertainty of the optimal method for following patients. After focal therapy, PSA testing is not accurate for predicting or identifying prostate cancer recurrence . Multiparametric MRI outperforms PSA testing for detecting prostate cancer recurrence after focal therapy .…”

Section: Discussionmentioning

confidence: 99%

“…High‐intensity focused ultrasound (HIFU) has been used for focal therapy in patients with localized prostate cancer . One of the challenges of focal therapy is surveillance during follow‐up, since there is no consensus on imaging modalities or valid markers to detect or predict postablation recurrence.…”

mentioning

confidence: 99%

Contrast‐Enhanced Transrectal Ultrasound for Follow‐up After Focal HIFU Ablation for Prostate Cancer

Abreu

Ashrafi

Gill

et al. 2018

J of Ultrasound Medicine

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The optimal strategy for imaging after focal therapy for prostate cancer is evolving. This series is an initial report on the use of contrast-enhanced transrectal ultrasound (TRUS) in follow-up of patients after high-intensity focused ultrasound (HIFU) hemiablation for prostate cancer. In 7 patients who underwent HIFU hemiablation, contrast-enhanced TRUS findings were as follows: (1) contrast-enhanced TRUS clearly showed the HIFU ablation defect as a sharply marginated nonenhancing zone in all patients; (2) contrast-enhanced TRUS identified suspicious foci of recurrent enhancement within the ablation zone in 2 patients, facilitating image-guided prostate biopsy, which showed prostate cancer; and (3) contrast-enhanced TRUS findings correlated with multiparametric magnetic resonance imaging and biopsy histologic findings.

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Focal High Intensity Focused Ultrasound of Unilateral Localized Prostate Cancer: A Prospective Multicentric Hemiablation Study of 111 Patients

Cited by 146 publications

References 25 publications

Hemi‐ablative low‐dose‐rate prostate brachytherapy for unilateral localised prostate cancer

Hemi‐ablative low‐dose‐rate prostate brachytherapy for unilateral localised prostate cancer

Using spatial tracking with magnetic resonance imaging/ultrasound‐guided biopsy to identify unilateral prostate cancer

Contrast‐Enhanced Transrectal Ultrasound for Follow‐up After Focal HIFU Ablation for Prostate Cancer

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