Focal Therapy for Localized Prostate Cancer with Either High Intensity Focused Ultrasound or Cryoablation: A Single Institution Experience

No AccessJournal of UrologyAdult Urology1 Feb 2020Focal Therapy for Localized Prostate Cancer with Either High Intensity Focused Ultrasound or Cryoablation: A Single Institution ExperienceThis article is commented on by the following:Editorial CommentEditorial Comment Rafael R. Tourinho-Barbosa, Rafael Sanchez-Salas, Oliver Rojas Claros, Sylvain Collura-Merlier, Arnas Bakavicius, Arie Carneiro, Armando Stabile, Marco Moschini, Nathalie Cathala, Marcos Tobias-Machado, and Xavier Cathelineau Rafael R. Tourinho-BarbosaRafael R. Tourinho-Barbosa Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Department of Urology, Faculdade de Medicina do ABC, São Paulo, Brazil , Rafael Sanchez-SalasRafael Sanchez-Salas *Correspondence: Department of Urology, Institut Mutualiste Montsouris, 42, Blvd. Jourdan, 75674, Paris, France telephone: +33-1-56-61-62-63; E-mail Address: [email protected] Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Oliver Rojas ClarosOliver Rojas Claros Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Sylvain Collura-MerlierSylvain Collura-Merlier Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Arnas BakaviciusArnas Bakavicius Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Arie CarneiroArie Carneiro Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Armando StabileArmando Stabile Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Marco MoschiniMarco Moschini Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Nathalie CathalaNathalie Cathala Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Marcos Tobias-MachadoMarcos Tobias-Machado Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Department of Urology, Faculdade de Medicina do ABC, São Paulo, Brazil , and Xavier CathelineauXavier Cathelineau Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France View All Author Informationhttps://doi.org/10.1097/JU.0000000000000506AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We report oncologic outcomes in patients treated with focal therapy for prostate cancer. Materials and Methods: We retrospectively analyzed a single institution cohort of men with localized prostate cancer who received focal therapy using high intensity focused ultrasound or cryotherapy from 2009 to 2018. Focal therapy was offered for low or intermediate risk disease (prostate specific antigen less than 20 ng/ml, Gleason score 7 or less and clinical stage T2b or less). Patients with previous prostate cancer treatment or less than 6 months of followup were excluded from study. Failure was defined as local or systemic salvage treatment, a positive biopsy Gleason score of 7 or greater in-field or out-of-field in nontreated patients, prostate cancer metastasis or prostate cancer specific death. Cox regression analysis was done to identify independent predictors of failure after focal therapy. Results: Of the 309 patients included in study 190 and 119 were treated with high intensity focused ultrasound and cryotherapy, respectively. Median followup was 45 months. At 1, 3 and 5 years the failure-free survival rate was 95%, 67% and 54%, and the radical treatment-free survival rate was 99%, 79% and 67%, respectively. The 5-year metastasis-free survival rate was 98% and no prostate cancer specific death was registered in this cohort. Before focal therapy a biopsy Gleason score of 7 (3 + 4) or greater (HR 2.4, p <0.001) and nadir prostate specific antigen (HR 2.2, p <0.001) were independently associated with failed focal therapy. In the salvage focal therapy setting in-field recurrence after primary focal therapy was associated with poorer failure-free survival (p=0.02). Conclusions: Almost half of the men were free of focal therapy failure 5 years after treatment. Still, a significant proportion experienced recurrence at the midterm followup. The preoperative biopsy Gleason score and nadir prostate specific antigen were significantly associated with treatment failure. 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No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPatel N, Hughes A, Zhang J, Brisbane W, Rastegarpour A, Afsahir S, Kwan L, Nguyen A, Sisk A, Raman S and Reiter R (2023) Utility of Magnetic Resonance Imaging for Localizing Prostate Cancer Near the Urethra in Men Who Are Candidates for Focal Gland AblationJournal of Urology, Stabile A, Sanchez-Salas R, Tourinho-Barbosa R, Macek P, Pellegrino F, Gandaglia G, Moschini M, Cathala N, Mombet A, Montorsi F, Briganti A and Cathelineau X (2021) Association between Lesion Location and Oncologic Outcomes after Focal Therapy for Localized Prostate Cancer Using Either High Intensity Focused Ultrasound or CryotherapyJournal of Urology, VOL. 206, NO. 3, (638-645), Online publication date: 1-Sep-2021.Ribeiro L, Stonier T, Stroman L, Tourinho-Barbosa R, Alghazo O, Winkler M, Dasgupta P, Popert R, Cathelineau X, Sanchez-Salas R, Murphy D, Emberton M and Cathcart P (2020) Is the Toxicity of Salvage Prostatectomy Related to the Primary Prostate Cancer Therapy Received?Journal of Urology, VOL. 205, NO. 3, (791-799), Online publication date: 1-Mar-2021.Chuang R, Kinnaird A, Kwan L, Sisk A, Barsa D, Felker E, Delfin M and Marks L (2020) Hemigland Cryoablation of Clinically Significant Prostate Cancer: Intermediate-Term Followup via Magnetic Resonance Imaging Guided BiopsyJournal of Urology, VOL. 204, NO. 5, (941-949), Online publication date: 1-Nov-2020.Abreu A, Peretsman S, Iwata A, Shakir A, Iwata T, Brooks J, Tafuri A, Ashrafi A, Park D, Cacciamani G, Kaneko M, Duddalwar V, Aron M, Palmer S and Gill I (2020) High Intensity Focused Ultrasound Hemigland Ablation for Prostate Cancer: Initial Outcomes of a United States SeriesJournal of Urology, VOL. 204, NO. 4, (741-747), Online publication date: 1-Oct-2020.Oishi M, Gill I, Tafuri A, Shakir A, Cacciamani G, Iwata T, Iwata A, Ashrafi A, Park D, Cai J, Desai M, Ukimura O, Bahn D and Abreu A (2020) Reply by AuthorsJournal of Urology, VOL. 204, NO. 1, (158-159), Online publication date: 1-Jul-2020.Smith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 203, NO. 2, (221-222), Online publication date: 1-Feb-2020.Related articlesJournal of Urology13 Nov 2019Editorial CommentJournal of Urology13 Nov 2019Editorial Comment Volume 203Issue 2February 2020Page: 320-330Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsbiopsycryotherapyultrasoundhigh-intensity focusedtransrectaltreatment failureprostatic neoplasmsMetricsAuthor Information Rafael R. Tourinho-Barbosa Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Department of Urology, Faculdade de Medicina do ABC, São Paulo, Brazil More articles by this author Rafael Sanchez-Salas Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France *Correspondence: Department of Urology, Institut Mutualiste Montsouris, 42, Blvd. Jourdan, 75674, Paris, France telephone: +33-1-56-61-62-63; E-mail Address: [email protected] Financial interest and/or other relationship with EDAP TMS. More articles by this author Oliver Rojas Claros Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Sylvain Collura-Merlier Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Arnas Bakavicius Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Arie Carneiro Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Armando Stabile Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Marco Moschini Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Nathalie Cathala Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Marcos Tobias-Machado Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Department of Urology, Faculdade de Medicina do ABC, São Paulo, Brazil More articles by this author Xavier Cathelineau Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval, principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. 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