Prostate cancer treatment by the latest focal HIFU device with MRI/TRUS-fusion control biopsies: A prospective evaluation

Hardenberg, Jost von; Westhoff, Niklas; Baumunk, D.; Hausmann, Daniel; Martini, Thomas; Marx, Alexander; Porubský, Štefan; Schostak, Martin; Michel, Maurice Stephan; Ritter, Manuel

doi:10.1016/j.urolonc.2018.05.022

Cited by 35 publications

(32 citation statements)

References 21 publications

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“…Patients underwent focal or regional HIFU, with 12 month post-operative biopsy demonstrating persistence of cancer in 8 of 20 patients (40%). 28 While many of these treatment failures represent Gleason 6 disease, ultimately 20% of the patients in this study proceeded to prostatectomy at one year follow up. No patient developed urinary complications, however, there was a mild 2 point reduction in average erectile function as measured by the International Index of Erectile Function(IIEF) in preoperatively potent patients at 12 months (CI 15.79–22.21; P = 0.044).…”

Section: Contemporary Treatments In Prostate Cancer Focal Therapymentioning

confidence: 93%

“…This was seen in a 2018 report by Hardenberg et al of 24 patients treated with a recently updated HIFU platfrom. 28 Nineteen patients had MRI visible lesions (PIRADS 3–5) and 5 had lesions undetectable by MRI. Patients underwent focal or regional HIFU, with 12 month post-operative biopsy demonstrating persistence of cancer in 8 of 20 patients (40%).…”

Section: Contemporary Treatments In Prostate Cancer Focal Therapymentioning

confidence: 99%

“…25 These results have been largely mirrored by smaller prior studies. 26–28 Among 5 studies, 171 patients were treated as part of published study protocols. In-field recurrences were detected in 0–21% of patients.…”

Section: Contemporary Treatments In Prostate Cancer Focal Therapymentioning

confidence: 99%

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Contemporary treatments in prostate cancer focal therapy

Ahdoot

Lebastchi

Türkbey

et al. 2019

Current Opinion in Oncology

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Purpose: Radical treatments for prostate cancer are associated with significant morbidity, including incontinence and erectile dysfunction. Advances in the field of prostate MRI and desire to reduce treatment morbidities have led to a rapid growth in focal treatments for prostate cancer. Here, we review novel focal prostate cancer treatments and their associated recent clinical data, with a particular focus on data reported within the last 24 months. Recent findings: High Intensity Focal Ultrasound (HIFU), Focal Laser Ablation (FLA), Irreversible Electroporation (IRE), Focal Cryotherapy, and Photodynamic Therapy (PDT) have been used as treatment modalities for localized prostate cancer treatment. Despite the great variety of treatment techniques, each of these modalities is characterized by a significant rate of prostate cancer persistence within treatment zones (6–50%) and the presence of residual cancer within the prostate on re-biopsy (24–49%). These treatments, however, are associated with very low rates of high-grade complications, rare incontinence, and only mild or transient reductions in erectile function. The most common adverse events are urinary tract infections, hematuria, and urinary retention. Summary: Prostate cancer focal therapy is an attractive option for well selected patients due to its low complication profile, however long-term oncologic outcome is still lacking and early recurrence rates are high, limiting the ability of most urologic associations from endorsing its routine use.

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Section: Contemporary Treatments In Prostate Cancer Focal Therapymentioning

confidence: 93%

Section: Contemporary Treatments In Prostate Cancer Focal Therapymentioning

confidence: 99%

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Contemporary treatments in prostate cancer focal therapy

Ahdoot

Lebastchi

Türkbey

et al. 2019

Current Opinion in Oncology

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“…If a new insertion of a catheter was required due to urinary retention, the time point of removal in the outpatient setting was recorded. Further details on the treatment workflow and follow-up protocol were reported in a previous publication [2]. Three to 6 months after HIFU, treatment-related infectious complications were recorded during the follow-up visit in our department.…”

Section: Hifu Treatment and Study Follow-upmentioning

confidence: 99%

“…Organ-sparing focal therapies of localized prostate cancer aim to efficiently treat intraprostatic cancer lesions and to avoid side effects of whole gland treatments. There is a growing body of studies presenting oncological and functional outcomes for patients treated with experimental therapies such as high-intensity focused ultrasound (HIFU) [1][2][3][4]. However, when reporting adverse events, studies commonly focus on those events affecting genitourinary function, which are voiding, continence, and potency.…”

Section: Introductionmentioning

confidence: 99%

Prospective Feasibility Study of Single-Shot Antibiotic Prophylaxis in Transrectal Focal Ablation of Prostate Cancer

et al. 2020

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Introduction: Urinary tract infections (UTI) represent the most frequent complications after transrectal focal ablation of prostate cancer. Single-shot antibiotic prophylaxis for prevention has not yet been described. Methods: In this cohort study of patients who received a high-intensity focused ultrasound (HIFU) ablation of prostate cancer within a registered prospective single-arm trial, we analyzed posttreatment UTI (≤30 days after HIFU) related to perioperative antibiotic management in an exploratory analysis: single-shot prophylaxis or targeted treatment for bacteriuria. Potential risk factors associated with UTI were evaluated by uni-and multivariate regression analyses. Results: In total, 55 patients were eligible for analysis. Of these, 76.4% received antibiotic single-shot prophylaxis. UTI occurred in 10.7% of all patients, 5.4% developed fever, 3.6% required hospitalization. An antibiotic single-shot prophylaxis helped to protect 90.5% of men from infectious complications. Estimated effects indicate that a longer posttreatment catheterization (OR 3.38, 95% CI 0.47-27.08) and larger ablation volume (OR 4.85, 95% CI 0.61-107.49) might be associated with the highest risk for UTI after treatment. Conclusion: Single-shot antibiotic prophylaxis compared to a targeted antibiotic treatment showed a similar effectivity to prevent patients from infectious complications and should be considered as an element of antibiotic stewardship. Further research on risk factors and antibiotic strategies is required.

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