title: Focal High-intensity Focused Ultrasound Targeted Hemiablation for Unilateral Prostate Cancer: A Prospective Evaluation of Oncologic and Functional Outcomes.
abstract: BACKGROUND
  In selected patients with unilateral, organ-confined prostate cancer (PCa), hemiablation of the affected lobe might be feasible to achieve acceptable cancer control with fewer complications.
  
  
  OBJECTIVE
  To assess the oncologic and functional outcomes of focal high-intensity focused ultrasound (HIFU) hemiablation in unilateral organ-confined PCa.
  
  
  METHODS
  Single-center prospective evaluation of HIFU hemiablation for unilateral organ-confined PCa was performed from July 2009 through December 2013.
  
  
  METHODS
  Cancer localization was done with transrectal ultrasound-guided biopsy and multiparametric magnetic resonance imaging followed by HIFU hemiablation.
  
  
  METHODS
  Oncologic outcomes were analyzed with control biopsies and prostate-specific antigen (PSA) measurement. Functional outcomes were assessed with validated questionnaires for genitourinary symptoms.
  
  
  CONCLUSIONS
  Of 71 HIFU hemiablation patients, 67 completed the study protocol. The mean age was 70.2 yr (standard deviation: 6.8 yr), and median PSA was 6.1 ng/ml (interquartile range [IQR]: 1.6-15.5 ng/ml). Median maximum cancer-core length was 3 mm (IQR: 2-10 mm), and total cancer length was 6.5 mm (IQR: 2-24 mm). Gleason score was 6 (3+3) in 58 patients (86.6%) and 7 (3+4) in 9 patients (13.4%). Median follow-up was 12 mo (IQR: 6-50 mo), and at 12 mo, 56 of 67 patients had a negative control biopsy in the treated lobe. At 3 mo, all patients were continent, and potency was maintained in 11 of 21 preoperatively potent patients (confidence interval, 0.18-0.69). Complications included 8% Clavien-Dindo grade 2 and 2.8% grade 3 events.
  
  
  CONCLUSIONS
  Focal HIFU hemiablation appears to achieve acceptable oncologic outcomes with low morbidity and minimal functional changes. Longer follow-up will establish future considerations.
  
  
  RESULTS
  This study showed that high-intensity focused ultrasound hemiablation in selected patients with unilateral organ-confined prostate cancer can be used for satisfactory cancer control with minimal effect on genitourinary functions.
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Ernesto R Cordeiro
authors.initials: ER
authors.lastname: Feijoo
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Arjun
authors.initials: A
authors.lastname: Sivaraman
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. Electronic address: eric.barret@imm.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Galiano
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Rozet
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Prapotnich
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Cathala
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Annick
authors.initials: A
authors.lastname: Mombet
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
mesh_terms: D000368:Aged; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D047368:Tumor Burden; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects; D014549:Urinary Incontinence / Q000209:etiology
chemical_list: D017430:Prostate-Specific Antigen
keywords: Focal therapy; Hemiablation; High-intensity focused ultrasound; Prostate cancer