title: Focal High Intensity Focused Ultrasound of Unilateral Localized Prostate Cancer: A Prospective Multicentric Hemiablation Study of 111 Patients.
abstract: Up to a third of patients with localized prostate cancer have unilateral disease that may be suitable for partial treatment with hemiablation.
  
  
  
  To evaluate the ability of high intensity focused ultrasound (HIFU) to achieve local control of the tumor in patients with unilateral localized prostate cancer.
  
  
  
  The French Urological Association initiated a prospective IDEAL multi-institutional study (2009-2015), to evaluate HIFU-hemiablation as a primary treatment.
  
  
  
  Multiparametric magnetic resonance imaging and biopsy were used for unilateral cancer diagnosis and control, and HIFU-hemiablation.
  
  
  
  Primary: absence of clinically significant cancer (CSC) on control biopsy at 1 yr (CSC: Gleason score ≥ 7 or cancer core length>3mm regardless of grade or > 2 positive cores). Secondary: presence of any cancer on biopsy, biochemical response, radical treatment free survival, adverse events, continence (no pad), erectile function (International Index of Erectile Function-5 ≥ 16), and quality of life (European Organization for Research and Treatment of Cancer QLQ-C28) questionnaires.
  
  
  
  One hundred and eleven patients were treated (mean age: 64.8 yr [standard deviation 6.2]; mean prostate-specific antigen: 6.2 ng/ml [standard deviation 2.6]; 68% low risk, 32% intermediate risk). Of the 101 patients with control biopsy, 96 (95%) and 94 (93%) had no CSC in the treated and contralateral lobes, respectively. Mean prostate-specific antigen at 2 yr was 2.3 ng/ml (standard deviation 1.7). The radical treatment-free survival rate at 2 years was 89% (radical treatments: six radical prostatectomies, three radiotherapies, and two HIFU). Adverse events were Grade 3 in 13%. At 12 mo continence and erectile functions were preserved in 97% and 78%. No significant decrease in quality of life score was observed at 12 mo. One limitation is the number of low-risk patients included in this study.
  
  
  
  At 1 yr, HIFU-hemiablation was efficient with 95% absence of clinically significant cancer associated with low morbidity and preservation of quality of life. Radical treatment-free survival rate was 89% at 2 yr.
  
  
  
  This report shows that high intensity focused ultrasound half-gland treatment of unilateral prostate cancer provides promising results with high cancer control and low morbidity.
authors.affiliation: Department of Urology, Rangueil University Hospital, Toulouse, France. Electronic address: rischmann.p@chu-toulouse.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Rischmann
authors.affiliation: Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France; Department of Urology, Université de Lyon, Lyon, France; INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France.
authors.forename: Albert
authors.initials: A
authors.lastname: Gelet
authors.affiliation: Department of Urology, Université de Lyon, Lyon, France; Hospices Civils de Lyon, Service de Biostatistiques, Lyon, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Riche
authors.affiliation: Department of Urology, Huriez Hospital, Lille University, France.
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.affiliation: Department of Urology, CHU Pellegrin, Bordeaux, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Pasticier
authors.affiliation: Department of Urology, General Hospital of Chambéry, Chambéry, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bondil
authors.affiliation: Department of Urology, Pasteur Hospital, Colmar, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Jung
authors.affiliation: Department of Urology, University Hospital of Rouen, Rouen, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Bugel
authors.affiliation: Department of Urology and Transplantation, South Hospital of Amiens, Amiens, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Petit
authors.affiliation: Department of Surgical Urology, North Hospital of Marseille, Marseille, France.
authors.forename: Harry
authors.initials: H
authors.lastname: Toledano
authors.affiliation: Department of Urology, Saint-Michel Clinic, Toulon, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Mallick
authors.affiliation: Department of Urology, Université de Lyon, Lyon, France; INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France; Department of Radiology, Edouard Herriot Hospital, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rouvière
authors.affiliation: Department of Urology, Université de Lyon, Lyon, France; Hospices Civils de Lyon, Service de Biostatistiques, Lyon, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Rabilloud
authors.affiliation: Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Tonoli-Catez
authors.affiliation: Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France; Department of Urology, Université de Lyon, Lyon, France; INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Crouzet
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal
keywords: Focal therapy; Hemiablation; High-intensity focused ultrasound; Prospective trial; Prostate cancer