Extra-target low-risk prostate cancer: implications for focal high-intensity focused ultrasound of clinically significant prostate cancer
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To analyse the impact of the presence of extra-target non-clinically significant cancer (NCSC) after high-intensity focused ultrasound (HIFU) hemiablation on oncological results. To analyse radical treatment free survival (RTFS) rates at 2–3 years follow-up.
Retrospective single-centre study of 55 patients treated by primary HIFU hemiablation from 2010 to 2016. Inclusion criteria were unilateral MRI detected CSC, stage ≤ T2b, Gleason score (GS) ≤ 7, at least 6 mm distant from prostate apex. MRI with systematic and targeted biopsies was performed at diagnosis. Follow-up included clinical examination, PSA every 6 month, MRI and biopsies at 1 year and in case of PSA elevation. HIFU retreatment was possible. Whole-gland treatment was indicated in case of positive biopsies with GS ≥ 7 or maximum cancer core length > 5 mm, any GS.
Mean follow-up was 33 months (SD: 17–49 months). Presence or not of an extra-target NCSC in the untreated part of the gland had no impact on RTFS at univariate analysis (p = 0.29). 10 (18%) patients had a salvage whole-gland treatment after a median follow-up of 26 months (IQR 17–28). RTFS at 2 and 3 years were 92% and 80%.
Presence or not of an extra-target NCSC in the untreated part of the gland had no impact on RTFS. NCSC lesion can be left untreated and actively monitored. RTFS was 80% at 3 years which support the concept of focal/partial treatment as a treatment option of CSC prostate cancer.
KeywordsProstate cancer Focal therapy Index lesion Secondary lesion High-intensity focused ultrasound
AA: Manuscript writing/editing, data collection or management/protocol/project development. JO: Manuscript writing/editing. PV: Data collection or management. VD: Data analysis. XL: Data collection or management. PP: Data collection or management. AV: Manuscript writing/editing, data collection or management/protocol/project development.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
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