title: Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort.
abstract: High-intensity focused ultrasound (HIFU) is a minimally-invasive treatment for nonmetastatic prostate cancer.
  
  
  
  To report medium-term outcomes in men receiving primary whole-gland HIFU from a national multi-centre registry cohort.
  
  
  
  Five-hundred and sixty-nine patients at eight hospitals were entered into an academic registry.
  
  
  
  Whole-gland HIFU (Sonablate 500) for primary nonmetastatic prostate cancer. Redo-HIFU was permitted as part of the intervention.
  
  
  
  Our primary failure-free survival outcome incorporated no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included adverse events and genitourinary function.
  
  
  
  Mean age was 65 yr (47-87 yr). Median prostate-specific antigen was 7.0 ng/ml (interquartile range 4.4-10.2). National Comprehensive Cancer Network low-, intermediate-, and high-risk disease was 161 (28%), 321 (56%), and 81 (14%), respectively. One hundred and sixty three of 569 (29%) required a total of 185 redo-HIFU procedures. Median follow-up was 46 (interquartile range 23-61) mo. Failure-free survival at 5 yr after first HIFU was 70% (95% confidence interval [CI]: 64-74). This was 87% (95% CI: 78-93), 63% (95% CI: 56-70), and 58% (95% CI: 32-77) for National Comprehensive Cancer Network low-, intermediate-, and high-risk groups, respectively. Fifty eight of 754 (7.7%) had one urinary tract infection, 22/574 (2.9%) a recurrent urinary tract infection, 22/754 (3%) epididymo-orchitis, 227/754 (30%) endoscopic interventions, 1/754 (0.13%) recto-urethral fistula, and 1/754 (0.13%) osteitis pubis. Of 206 known to be pad-free pre-HIFU, 183/206 (88%) remained pad free, and of 236 with good baseline erectile function, 91/236 (39%) maintained good function. The main limitation is lack of long-term data.
  
  
  
  Whole-gland HIFU is a repeatable day-case treatment that confers low rates of urinary incontinence. Disease control at a median of just under 5 yr of follow-up demonstrates its potential as a treatment for nonmetastatic prostate cancer. Endoscopic interventions and erectile dysfunction rates are similar to other whole-gland treatments.
  
  
  
  In this report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.
authors.affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Dickinson
authors.affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK; Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK.
authors.forename: Manit
authors.initials: M
authors.lastname: Arya
authors.affiliation: Department of Urology, Dorset County Hospital, Dorchester, UK.
authors.forename: Naveed
authors.initials: N
authors.lastname: Afzal
authors.affiliation: Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Cathcart
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Charman
authors.affiliation: Department of Urology, Dorset County Hospital, Dorchester, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cornaby
authors.affiliation: Department of Urology, Basingstoke Hospital, Hampshire Hospitals NHS Foundation Trust, Hampshire, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Hindley
authors.affiliation: Department of Urology, Broomfield Hospital, Mid Essex NHS Trust, Chelmsford, UK.
authors.forename: Henry
authors.initials: H
authors.lastname: Lewi
authors.affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: McCartan
authors.affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Moore
authors.affiliation: Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Senthil
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Ogden
authors.affiliation: Department of Urology, North Bristol NHS Trust, Bristol, UK.
authors.forename: Raj
authors.initials: R
authors.lastname: Persad
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
authors.affiliation: Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Shraddha
authors.initials: S
authors.lastname: Weir
authors.affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
authors.affiliation: Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK. Electronic address: hashim.ahmed@ucl.ac.uk.
authors.forename: Hashim U
authors.initials: HU
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D057086:High-Intensity Focused Ultrasound Ablation / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D012042:Registries; D019233:Retreatment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
keywords: High-intensity focused ultrasound