title: Morbidity of focal therapy in the treatment of localized prostate cancer.
abstract: BACKGROUND
  Focal therapy (FT) for prostate cancer (PCa) seems to be part of a natural evolution in the quest to improve the management of early organ-confined disease.
  
  
  OBJECTIVE
  To assess the morbidity of the initial experience of FT in a tertiary referral center for PCa management.
  
  
  METHODS
  From 2009 to 2011, a total of 1213 patients with clinically localized PCa were treated at our institution. Of these patients, 547 were considered to have indolent disease according to the D'Amico criteria for low-risk disease plus unilateral disease with a maximum of three positive biopsies. A total of 106 patients underwent FT using high-intensity focused ultrasonography (HIFU), brachytherapy, cryotherapy, or vascular-targeted photodynamic therapy (VTP).
  
  
  METHODS
  Complications were prospectively recorded and graded according to the Clavien-Dindo scale. Data were prospectively collected and retrospectively analyzed.
  
  
  CONCLUSIONS
  This study included 106 patients, median age 66.5 yr (interquartile range [IQR]): 61-73), who had a prostate hemiablation; 50 patients (47%) had cryotherapy, 23 patients (22%) had VTP, 21 patients (20%) received HIFU, and 12 patients (11%) had brachytherapy. The median prostate-specific antigen (PSA) level was 6.1 ng/ml (IQR: 5-8.1), all the patients had a biopsy Gleason score of 6, and the median prostate weight was 43 g (IQR: 33-55). The median International Prostate Symptom Score was 6 (IQR: 3-10), and the median International Index of Erectile Function score was 20 (IQR: 15-23). After treatment, the median PSA at 3, 6, and 12 mo was 3.1 2.9, and 2.7 ng/ml (IQR: 2-5.1, 1.1-4.7, and 1-4.4), respectively. Thirteen percent of the patients experienced treatment-related complications. There were 11 minor medical complications (10 grade 1 complications and 1 grade 2 complication), 2 grade 3 complications, and no grade 4 or higher complications.
  
  
  CONCLUSIONS
  FT for a highly selected population with PCa is feasible and had an acceptable morbidity with <2% major complications.
authors.affiliation: Urology Service, Department of Surgery, Institut Mutualiste Montsouris, Paris, France. eric.barret@imm.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.forename: Youness
authors.initials: Y
authors.lastname: Ahallal
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.forename: Marc
authors.initials: M
authors.lastname: Galiano
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Cosset
authors.forename: Pierre
authors.initials: P
authors.lastname: Validire
authors.forename: Petr
authors.initials: P
authors.lastname: Macek
authors.forename: Matthieu
authors.initials: M
authors.lastname: Durand
authors.forename: Dominique
authors.initials: D
authors.lastname: Prapotnich
authors.forename: François
authors.initials: F
authors.lastname: Rozet
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D017679:Cryotherapy / Q000009:adverse effects / Q000379:methods*; D057086:High-Intensity Focused Ultrasound Ablation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000628:therapy*; D016896:Treatment Outcome