Evaluation of functional outcomes after a second focal high-intensity focused ultrasonography (HIFU) procedure in men with primary localized, non-metastatic prostate cancer: results from the HIFU Evaluation and Assessment of Treatment (HEAT) registry

Catherine E Lovegrove^{1

2}, Max Peters³, Stephanie Guillaumier^{4

5}, Manit Arya^{1

5

6}, Naveed Afzal⁷, Tim Dudderidge⁸, Feargus Hosking-Jervis^{2

3}, Richard G Hindley⁹, Henry Lewi¹⁰, Neil McCartan^{4

5}, Caroline M Moore^{4

5}, Raj Nigam^{6

11}, Chris Ogden¹², Raj Persad¹³, Jaspal Virdi⁶, Mathias Winkler¹, Mark Emberton^{4

5}, Hashim U Ahmed^{1

2}, Taimur T Shah^{1

2

4}, Suks Minhas^{1

2}

Affiliations

¹ Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
² Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
³ Department of Radiation Oncology, Cancer Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.
⁴ Division of Surgery and Interventional Sciences, University College London, London, UK.
⁵ Department of Urology, UCLH NHS Foundation Trust, London, UK.
⁶ Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK.
⁷ Department of Urology, Dorset County Hospital NHS Trust, Dorset, UK.
⁸ Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
⁹ Department of Urology, Hampshire Hospitals NHS Foundation Trust, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
¹⁰ Springfield Hospital, Chelmsford, UK.
¹¹ Department of Urology, Royal Surrey County Hospital NHS Trust, Surrey, UK.
¹² Department of Academic Urology, Royal Marsden Hospital NHS Foundation Trust, London, UK.
¹³ Department of Urology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.

PMID: 31971335
DOI: 10.1111/bju.15004

Multicenter Study

Evaluation of functional outcomes after a second focal high-intensity focused ultrasonography (HIFU) procedure in men with primary localized, non-metastatic prostate cancer: results from the HIFU Evaluation and Assessment of Treatment (HEAT) registry

Catherine E Lovegrove et al. BJU Int. 2020 Jun.

. 2020 Jun;125(6):853-860.

doi: 10.1111/bju.15004. Epub 2020 Feb 11.

Authors

Affiliations

¹ Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
² Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
³ Department of Radiation Oncology, Cancer Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.
⁴ Division of Surgery and Interventional Sciences, University College London, London, UK.
⁵ Department of Urology, UCLH NHS Foundation Trust, London, UK.
⁶ Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK.
⁷ Department of Urology, Dorset County Hospital NHS Trust, Dorset, UK.
⁸ Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
⁹ Department of Urology, Hampshire Hospitals NHS Foundation Trust, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
¹⁰ Springfield Hospital, Chelmsford, UK.
¹¹ Department of Urology, Royal Surrey County Hospital NHS Trust, Surrey, UK.
¹² Department of Academic Urology, Royal Marsden Hospital NHS Foundation Trust, London, UK.
¹³ Department of Urology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.

PMID: 31971335
DOI: 10.1111/bju.15004

Abstract

Objectives: To assess change in functional outcomes after a second focal high-intensity focused ultrasonography (HIFU) treatment compared with outcomes after one focal HIFU treatment.

Patients and methods: In this multicentre study (2005-2016), 821 men underwent focal HIFU for localized non-metastatic prostate cancer. The patient-reported outcome measures of International Prostate Symptom Score (IPSS), pad usage and erectile function (EF) score were prospectively collected for up to 3 years. To be included in the study, completion of at least one follow-up questionnaire was required. The primary outcome was comparison of change in functional outcomes between baseline and follow-up after one focal HIFU procedure vs after a second focal HIFU procedure, using IPSS, Expanded Prostate Cancer Index Composite (EPIC) and International Index of Erectile Function (IIEF) questionnaires.

Results: Of 821 men, 654 underwent one focal HIFU procedure and 167 underwent a second focal HIFU procedure. A total of 355 (54.3%) men undergoing one focal HIFU procedure and 65 (38.9%) with a second focal HIFU procedure returned follow-up questionnaires, respectively. The mean age and prostate-specific antigen level were 66.4 and 65.6 years, and 7.9 and 8.4 ng/mL, respectively. After one focal HIFU treatment, the mean change in IPSS was -0.03 (P = 0.02) and in IIEF (EF score) it was -0.4 (P = 0.02) at 1-2 years, with no subsequent decline. Absolute rates of erectile dysfunction increased from 9.9% to 20.8% (P = 0.08), leak-free continence decreased from 77.9% to 72.8% (P = 0.06) and pad-free continence from 98.6% to 94.8% (P = 0.07) at 1-2 years, respectively. IPSS prior to second focal HIFU treatment compared to baseline IPSS prior to first focal HIFU treatment was lower by -1.3 (P = 0.02), but mean IPSS change was +1.4 at 1-2 years (P = 0.03) and +1.2 at 2-3 years (P = 0.003) after the second focal HIFU treatment. The mean change in EF score after the second focal HIFU treatment was -0.2 at 1-2 years (P = 0.60) and -0.5 at 2-3 years (P = 0.10), with 17.8% and 6.2% of men with new erectile dysfunction. The rate of new pad use was 1.8% at 1-2 years and 2.6% at 2-3 years.

Conclusion: A second focal HIFU procedure causes minor detrimental effects on urinary function and EF. These data can be used to counsel patients with non-metastatic prostate cancer prior to considering HIFU therapy.

Keywords: #PCSM; #ProstateCancer; functional outcomes; high-intensity focal ultrasonography; localized prostate cancer.

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References

1. 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: 422-9
1. Davda R, Orczyk C, Prentice M et al. Late toxicity described using patient reported outcomes measures (PROMS) in men treated with salvage radiation following primary high intensity focal ultrasound (HIFU) for localized prostate cancer. J Clin Oncol 2019; 37(7_suppl): 131
1. Yap T, Ahmed HU, Hindley RG et al. The effects of focal therapy for prostate cancer on sexual function: a combined analysis of three prospective trials. Eur Urol 2016; 69: 844-51
1. Berge V, Dickinson L, McCartan N et al. Morbidity associated with primary high intensity focused ultrasound and redo high intensity focused ultrasound for localized prostate cancer. J Urol 2014; 191: 1764-9
1. Ahmed HU, Hu Y, Carter T et al. Characterizing clinically significant prostate cancer using template prostate mapping biopsy. J Urol 2011; 186: 458-64

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Evaluation of functional outcomes after a second focal high-intensity focused ultrasonography (HIFU) procedure in men with primary localized, non-metastatic prostate cancer: results from the HIFU Evaluation and Assessment of Treatment (HEAT) registry

Affiliations

Evaluation of functional outcomes after a second focal high-intensity focused ultrasonography (HIFU) procedure in men with primary localized, non-metastatic prostate cancer: results from the HIFU Evaluation and Assessment of Treatment (HEAT) registry

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical