Advertisement

Oncological Long-term Outcome After Whole-gland High-intensity Focused Ultrasound for Prostate Cancer—21-yr Follow-up

Published:January 19, 2021DOI:https://doi.org/10.1016/j.euf.2020.12.016

      Abstract

      Background

      Owing to the morbidity of established radical treatment options for prostate cancer, alternative whole-gland and focal treatment strategies have emerged. High-intensity focused ultrasound (HIFU) is one of the most studied sources for tissue ablation and has been used since the 1990s.

      Objective

      To provide 21-yr oncological long-term follow-up data of an unselected series of patients who underwent whole-gland HIFU for nonmetastatic prostate cancer.

      Design, setting, and participants

      A total of 674 patients were treated between November 1997 and November 2012 in one university center.

      Outcome measurements and statistical analysis

      The oncological outcome was assessed by biopsy failure–free survival (BFFS), salvage treatment–free survival (STFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Multivariable Cox proportional hazard regression analyses were performed to estimate the prognostic relevance of clinical variables.

      Results and limitations

      In total, 560 patients were included into the evaluation and the median follow-up was 15.1 yr, with a range up to 21.4 yr. At 15 yr, CSS rates for low-, intermediate-, and high-risk patients were 95%, 89%, and 65%, respectively; MFS, STFS-1 (salvage treatment other than HIFU), STFS-2 (salvage treatment including repeat HIFU), and BFFS rates were 91%, 85%, and 58%; 77%, 63%, and 29%; 67%, 52%, and 28%; and 82%, 73%, and 47%, respectively. Preoperative high-risk category was an independent predictor of inferior OS, CSS, MFS, STFS, and BFFS.

      Conclusions

      Although whole-gland HIFU achieved good long-term cancer control in low- and intermediate-risk patients, high-risk patients should not be treated routinely by HIFU. Intermediate-risk patients achieve high CSS and MFS rates, but a relevant salvage treatment rate has to be reckoned with. Long-term data after whole-gland therapy might help derive implications for focal treatment sources and patient selection.

      Patient summary

      Long-term data after whole-gland high-intensity focused ultrasound (HIFU) therapy are crucial to prove its oncological efficacy, and may help derive implications for focal treatment strategies and patient selection. In this context, whole-gland HIFU achieved good long-term cancer control up to 21 yr in low- and intermediate-risk prostate cancer (PCa) patients. Owing to considerably inferior long-term cancer control, it should not routinely be used in high-risk PCa patients.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Global Burden of Disease Cancer C
        • Fitzmaurice C.
        • Akinyemiju T.F.
        • et al.
        Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: a systematic analysis for the global burden of disease study.
        JAMA Oncol. 2018; 4: 1553-1568
        • Cornford P.
        • Bellmunt J.
        • Bolla M.
        • et al.
        EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer.
        Eur Urol. 2017; 71: 630-642
        • Ganzer R.
        • Arthanareeswaran V.K.A.
        • Ahmed H.U.
        • et al.
        Which technology to select for primary focal treatment of prostate cancer?—European Section of Urotechnology (ESUT) position statement.
        Prostate Cancer Prostatic Dis. 2018; 21: 175-186
        • Chaussy C.G.
        • Thuroff S.
        High-Intensity focused ultrasound for the treatment of prostate cancer: a review.
        J Endourol. 2017; 31: S30-S37
        • Wilt T.J.
        • Jones K.M.
        • Barry M.J.
        • et al.
        Follow-up of prostatectomy versus observation for early prostate cancer.
        N Engl J Med. 2017; 377: 132-142
        • Bill-Axelson A.
        • et al.
        Radical prostatectomy or watchful waiting in prostate cancer – 29-year follow-up.
        N Engl J Med. 2018; 379: 2319-2329
        • Hamdy F.C.
        • Donovan J.L.
        • Lane J.A.
        • et al.
        10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer.
        N Engl J Med. 2016; 375: 1415-1424
        • Ganzer R.
        • Fritsche H.M.
        • Brandtner A.
        • et al.
        Fourteen-year oncological and functional outcomes of high-intensity focused ultrasound in localized prostate cancer.
        BJU Int. 2013; 112: 322-329
        • Thuroff S.
        • Chaussy C.
        Evolution and outcomes of 3 MHz high intensity focused ultrasound therapy for localized prostate cancer during 15 years.
        J Urol. 2013; 190: 702-710
        • Crouzet S.
        • Chapelon J.Y.
        • Rouviere O.
        • et al.
        Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients.
        Eur Urol. 2014; 65: 907-914
        • Dickinson L.
        • Arya M.
        • Afzal N.
        • et al.
        Medium-term outcomes after whole-gland high-intensity focused ultrasound for the treatment of nonmetastatic prostate cancer from a multicentre registry cohort.
        Eur Urol. 2016; 70: 668-674
        • D’Amico A.V.
        • Whittington R.
        • Malkowicz S.B.
        • et al.
        Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer.
        JAMA. 1998; 280: 969-974
        • Rosenhammer B.
        • Ganzer R.
        • Zeman F.
        • et al.
        Oncological long-term outcome of whole gland HIFU and open radical prostatectomy: a comparative analysis.
        World J Urol. 2019; 37: 2073-2080
        • Roach 3rd, M.
        • Hanks G.
        • et al.
        Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference.
        Int J Radiat Oncol Biol Phys. 2006; 65: 965-974
        • Blana A.
        • Brown S.C.
        • Chaussy C.
        • et al.
        High-intensity focused ultrasound for prostate cancer: comparative definitions of biochemical failure.
        BJU Int. 2009; 104: 1058-1062
        • Crouzet S.
        • Rebillard X.
        • Chevallier D.
        • et al.
        Multicentric oncologic outcomes of high-intensity focused ultrasound for localized prostate cancer in 803 patients.
        Eur Urol. 2010; 58: 559-566
        • Guillaumier S.
        • Peters M.
        • Arya M.
        • et al.
        A Multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer.
        Eur Urol. 2018; 74: 422-429
        • Shah T.T.
        • Peters M.
        • Eldred-Evans D.
        • et al.
        Early-medium-term outcomes of primary focal cryotherapy to treat nonmetastatic clinically significant prostate cancer from a prospective multicentre registry.
        Eur Urol. 2019; 76: 98-105
        • Stabile A.
        • Orczyk C.
        • Hosking-Jervis F.
        • et al.
        Medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer.
        BJU Int. 2019; 124: 431-440
        • Tourinho-Barbosa R.R.
        • Sanchez-Salas R.
        • Claros O.R.
        • et al.
        Focal therapy for localized prostate cancer with either HIFU or cryoablation: a single institution experience.
        J Urol. 2020; 203: 320-330
        • Maurer T.
        • Robu S.
        • Schottelius M.
        • et al.
        (99m)Technetium-based prostate-specific membrane antigen-radioguided surgery in recurrent prostate cancer.
        Eur Urol. 2019; 75: 659-666
        • van der Poel H.G.
        • van den Bergh R.C.N.
        • Briers E.
        • et al.
        Focal therapy in primary localised prostate cancer: the European Association of Urology position in 2018.
        Eur Urol. 2018; 74: 84-91