MP55-01: Cancer control outcomes following focal therapy using HIFU in 1,379 men with non-metastatic prostate cancer: a multi-institute 15- year experience

DEEPIKA REDDY*, London, United Kingdom, Max Peters, Utrecht, Netherlands, Taimur Shah, London, United Kingdom, Marieke van Son, Utrecht, Netherlands, Mariana Tanaka Bertoncelli, London, United Kingdom, Philipp Huber, Luzern, Switzerland, Derek Lomas, Rochester, MN, Arnas Rakauskas, Lausanne, Switzerland, Saiful Miah, Amersham, United Kingdom, David Eldred-Evans, Stephanie Guillaumier, Feargus Hosking-Jervis, Ryan Engle, London, United Kingdom, Tim Dudderidge, Southampton, United Kingdom, Richard Hindley, Amr Emara, Basingstoke, United Kingdom, Raj Nigam, Guildford, United Kingdom, Neil McCartan, London, United Kingdom, Massimo Valerio, Lausanne, Switzerland, Naveed Afzal, Dorchester, United Kingdom, Henry Lewi, Chelmsford, United Kingdom, Clement Orczyk, Chris Ogden, London, United Kingdom, Iqbal Shergill, Wrexham, United Kingdom, Raj Persad, Bristol, United Kingdom, Jaspal Virdi, Harlow, United Kingdom, Caroline Moore, Manit Arya, Mathias Winkler, Mark Emberton, Hashim Ahmed, London, United Kingdom

Introduction: Focal therapy aims to treat areas of cancer to confer oncological control whilst reducing treatment-related functional detriment. We report oncological outcomes and adverse events following focal HIFU for treating non-metastatic prostate cancer.

Methods: 1379 patients with 6 months follow-up or greater prospectively recorded in the HEAT registry from 13 UK centres (2005-2020) were analysed. 5-year follow-up or greater was available in 325 (24%). Focal HIFU therapy used a transrectal ultrasound-guided device (Sonablate, Sonacare). 

Failure-free survival (FFS) was primarily defined as avoidance of no evidence of disease to require salvage whole-gland or systemic treatment, or metastases or prostate cancer-specific mortality. Differences in FFS between D’Amico risk groups were determined using log rank analysis. Adverse events were reported using Clavien-Dindo classification.

Results: Median (IQR) age was 66 years (60-71) and PSA 6.9ng/ml (4.9- 9.4) with D’Amico intermediate in 65% (896/1379) and high-risk in 28% (386/1379). Overall median follow-up was 32 (17-58) months; for those with =5 years follow-up 82 (72-94). 252 had repeat focal due to residual or recurrent cancer; overall 92 patients required salvage whole-gland treatment.

Overall, Kaplan-Meier 7-year FFS was 69% (64-74%) [Figure 1a]. 7-year FFS in intermediate and high-risk cancers was 68% (95%CI 62-75%) and 65% (95%CI 56-74%) (p=0.3) [Figure 1b]. Kaplan-Meier 7-year FFS in patients with at least 5 years follow up was 69% (64-74%). No difference in FFS (95% CI) at 7 years were demonstrated between intermediate and high- risk disease (68% (62-75%) vs 65% (56-74%)) respectively, p=0.3.

Clavien-Dindo >2 adverse events occurred in 0.4% (6/1379).

Conclusions: Focal HIFU in carefully selected patients with clinically significant prostate cancer, with 6 and 3 in 10 patients having intermediate and high-risk cancer, has good cancer control in the medium term.

Source of Funding: This study had no external funding sources