Ziel/Aim The urinary excretion of PSMA-ligands with resultant high bladder activity can obscure locally relapsing prostate cancer (PC) lesions in Positron-Emission-Tomography/Computed Tomography (PET/CT). While a number of studies report the role of forced diuresis in PSMA-PET/CT, its influence on local recurrence detectability has not been extensively studied, which this present study aims to address.

PURPOSE:We determined whether prostate specific antigen criteria after focal high intensity focused ultrasound to treat prostate cancer could diagnose treatment failure.MATERIALS AND METHODS:A total of 598 patients in a prospectively maintained national database underwent focal high intensity focused ultrasound with a Sonablate® 500 device from March 2007 to November 2016. Followup consisted of 3-month clinic visits and prostate specific antigen testing in year 1 with prostate specific antigen measurement every 6 to 12 months and multiparametric magnetic resonance imaging with biopsy for magnetic resonance imaging suspicious for recurrence. Treatment failure was considered any secondary treatment, tumor recurrence with Gleason 3 + 4 or greater disease on prostate biopsy without further treatment or metastasis and/or prostate cancer related mortality. To diagnose failure we evaluated a series of nadir + x thresholds with x values of 0.1 to 2.0 ng/ml.RESULTS:Median patient age was 65 years (IQR 60-71) and the median Gleason score was 7 (range 6-9). Gleason 3 + 4 or greater disease was present in 80% of cases. Tumors were radiologically staged as T1c-T2c in 522 of the 596 patients (88%) and as T3a/b in 74 (12.4%). Baseline median prostate specific antigen was 7.80 ng/ml (IQR 5.96-10.45) in failed cases and 6.77 ng/ml (IQR 2.65-9.71) in cases without failure. Optimal performance according to the Youden index to indicate the most appropriate nadir + x at all analyzed time points at 3-month intervals showed that nadir + 1.0 ng/ml would have 27.3% to 100% sensitivity and 39.4% to 85.6% specificity depending on the time of evaluation in the first 3 years. Nadir + 1.5 ng/ml showed 18.2% to 100% sensitivity and 60.6% to 91.8% specificity with nadir + 2.0 ng/ml leading to similar sensitivity and specificity ranges. Nadir + 1.0 ng/ml at 12 months and nadir + 1.5 ng/ml at 24 and 36 months had 100% sensitivity and 96.1% to 100% negative predictive value.CONCLUSIONS:Following focal high intensity focused ultrasound a prostate specific antigen nadir of 1.0 ng/ml at 12 months and 1.5 ng/ml at 24 to 36 months might be used to triage men requiring magnetic resonance imaging and biopsy. These data need prospective validation.

Objective To compare cancer control in anterior compared to posterior prostate cancer lesions treated with a focal HIFU therapy approach. Materials and methods In a prospectively maintained national database, 598 patients underwent focal HIFU (Sonablate ® 500) (March/2007–November/2016). Follow-up occurred with 3-monthly clinic visits and PSA testing in the first year with PSA, every 6–12 months with mpMRI with biopsy for MRI-suspicion of recurrence. Treatment failure was any secondary treatment (ADT/chemotherapy, cryotherapy, EBRT, RRP, or re-HIFU), tumour recurrence with Gleason ≥ 3 + 4 on prostate biopsy without further treatment or metastases/prostate cancer-related mortality. Cases with anterior cancer were compared to those with posterior disease. Results 267 patients were analysed following eligibility criteria. 45 had an anterior focal-HIFU and 222 had a posterior focal-HIFU. Median age was 64 years and 66 years, respectively, with similar PSA level of 7.5 ng/ml and 6.92 ng/ml. 84% and 82%, respectively, had Gleason 3 + 4, 16% in both groups had Gleason 4 + 3, 0% and 2% had Gleason 4 + 4. Prostate volume was similar (33 ml vs. 36 ml, p = 0.315); median number of positive cores in biopsies was different in anterior and posterior tumours (7 vs. 5, p = 0.009), while medium cancer core length, and maximal cancer percentage of core were comparable. 17/45 (37.8%) anterior focal-HIFU patients compared to 45/222 (20.3%) posterior focal-HIFU patients required further treatment ( p = 0.019). Conclusion Treating anterior prostate cancer lesions with focal HIFU may be less effective compared to posterior tumours.

Objective To compare cancer control rates of standard compared to dose escalation focal high-intensity focused ultrasound (HIFU) of prostate cancer. Materials and methods A prospectively maintained HIFU (Sonablate® 500) database identified 598 patients were identified who underwent focal HIFU (Sonablate® 500) (March/2007-November/2016). Follow-up occurred with 3-monthly clinic visits and PSA testing in the first year. Thereafter, PSA was measured 6-monthly. mpMRI with biopsy was used for MRI-suspicion of recurrence. Treatments were delivered in a quadrant or hemiablation fashion depending on the gland volume as well as tumour volume and location. Prior to mid-2015, standard focal-HIFU was used (two HIFU blocks); after this date some urologists conducted dose escalation focal-HIFU (3 overlapping HIFU blocks). Propensity matching was used to ensure two matched groups leading to 162 cases for this analysis. Treatment failure was defined by any secondary treatment (systemic therapy, cryotherapy, radiotherapy, prostatectomy, or further HIFU), metastasis from prostate cancer without further treatment, tumour recurrence with Gleason score >/=7 (>/=3+4) on prostate biopsy without further treatment, or prostate cancer-related mortality. Complications and side-effects were also compared. Results Median age was 64.5 years (IQR 60-73.5) in the standard focal-HIFU group and 64.5 years (IQR 60-69) in the dose-escalation group. Median prostate volume was 37ml (IQR 17-103) in standard group and 47.5ml (IQR 19-121) in the dose-escalation group. As tumour volume on mpMRI and Gleason score were major matching criteria these were identical with 0.43ml (IQR 0.05-2.5) and Gleason 3+3=6 in 1/32 (3%), 3+4=7 in 27/32 (84%), and 4+3=7 in 4/32 (13%). Recurrence in treated areas were found in 10/32 (31%) when standard treatment zones were applied, and in 6/32 (19%) of dose-escalation focal-HIFU (p=0.007). Conclusion This exploratory study shows that dose escalation focal-HIFU may achieve higher rates of disease control compared to standard focal-HIFU. Further prospective comparative studies are needed.

PURPOSE:Dual-time point PET/CT scanning with [68Ga]Ga-PSMA-11 in the diagnosis of prostate cancer (PC) has been advanced as a method to increase detection of PC lesions, particularly at early stages of biochemical recurrence and as a potential means to aid the discrimination between benign and pathological prostate-specific membrane antigen (PSMA) uptake. However, the assumption that all PC lesions uniformly exhibit increasing tracer uptake at delayed imaging has not yet been investigated, which this present study aims to address.METHODS:One hundred consecutive patients with biochemically recurrent PC who received standard and late [68Ga]Ga-PSMA-11 PET/CT (by local protocol at 1.5 h "standard" and 2.5 h p.i. "late") underwent retrospective evaluation. All lesions with a tracer uptake above local background were analysed with regard to their maximum standardised uptake values at standard and late images (SUVmax) and characterised according to their morphological characteristics.RESULTS:Seventy-nine of 100 patients had PSMA-positive scans, in whom a total of 185 individual PSMA-positive lesions were identified. These were morphologically characterised as bone lesions (n = 48), solid organ lesions (n = 3), lymph node (LN) lesions (n = 78) and locally recurrent lesions in the prostatic fossa or seminal vesicles (n = 56). The relative uptake between standard and late imaging was considered; all lesions classified as local recurrence presented with increasing (86%) or stable patterns of tracer uptake (14%). In contrast, only 58% of bone lesions exhibited increasing tracer uptake, with 21% exhibiting a stable pattern and 21% exhibiting a decreasing tracer uptake at late imaging.CONCLUSION:A heterogeneous pattern of dynamic tracer uptake was observed, with a largely increasing pattern observed for locally recurrent lesions and lymph nodes and a significant proportion of bone lesions exhibiting decreasing tracer uptake. The results are of significance not only in the imaging and identification of PC lesions, but they also have implications for PSMA-directed ligand therapy.

Purpose So far, there have been very few studies which provide a direct comparison between MRI and PSMA-ligand PET/CT for the detection of recurrent prostate cancer (rPC). This present study therefore aims to provide further clinical data in order to resolve this urgent clinical question, and thereby strengthen clinical recommendations. Methods A retrospective analysis was performed for patients who were scanned at our institution with whole-body PSMA-PET/CT (tracer: 68Ga-PSMA-11) between January 2017 and September 2018 in order to detect rPC. Amongst them, 43 underwent an additional pelvic MRI within 2 months. Both modalities were compared as follows: a consensus read of the PET data was performed by two nuclear physicians. All lesions were recorded with respect to their type and localization. The same process was conducted by two radiologists for pelvic MRI. Thereafter, both modalities were directly compared for every patient and lesion. Results Overall, 30/43 patients (69.8%) presented with a pathologic MRI and 38/43 (88.4%) with a pathologic PSMA-PET/CT of the pelvis. MRI detected 53 pelvic rPC lesions (13 of them classified as "uncertain") and PSMA-PET/CT detected 75 pelvic lesions (three classified as "uncertain"). The superiority of PSMA-PET/CT was statistically significant only if uncertain lesions were classified as false-positive. Conclusions PSMA-PET/CT detected more pelvic lesions characteristic for rPC when compared to MRI. In order to detect rPC, a potential future scenario could be conducting first a PSMA-PET/CT. Combining the advantages of both modalities in hybrid PET/MRI scanners would be an ideal future scenario.

68Ga-PSMA-11 PET/CT is commonly performed at 1 h post injection (p.i.). However, various publications have demonstrated that most prostate cancer (PC) lesions exhibit higher contrast at later imaging. The aim of this study was to compare the “common” protocol of 68Ga-PSMA-11 PET/CT with a modified protocol. In 2017, we used the following scanning protocol for 68Ga-PSMA-11 PET/CT in patients with recurrent PC: acquisition at 1 h p.i. without further preparations. From 2018, all scans were conducted at 1.5 h p.i. In addition, patients were orally hydrated with 1 L of water 0.5 h p.i. and were injected with 20 mg of furosemide 1 h p.i. Both protocols including 112 patients (2017) and 156 (modified protocol in 2018) were retrospectively compared. Rates of pathologic scans, maximum standardized uptake values (SUVmax), and tumor contrast (ratio lesion-SUVmax/background-SUVmean) as well as average standardized uptake values (SUVmean) of urinary bladder were analyzed. Both tumor contrast and tracer uptake were significantly (p < 0.001) higher in the novel protocol. Although statistically not significant, the rates of pathologic scans were also higher in the modified protocol: 76.3% vs. 68.8% for all PSA values including 38.9% vs. 25.0% for PSA < 0.5 ng/ml and 60.0% vs. 56.7% for PSA > 0.5–≤ 2.0 ng/ml. Average SUVmean of the urinary bladder was significantly (p < 0.001) lower with the modified protocol. The modified protocol, which includes a combination of delayed image acquisition at 1.5 h p.i., hydration, and furosemide resulted in higher tumor contrast and seems to have the potential to increase the rates of pathological scans, especially at low PSA levels.

PURPOSE:Differentiating between prostate cancer (PC) lesions and benign structures which exhibit radiotracer uptake in PSMA-ligand PET/CT can be challenging. Additional late imaging has been shown to be a powerful method for the discrimination between PC and non-PC lesions, owing to the increasing tracer uptake of the former. Nevertheless, there are no pre-existing studies which describe the dynamic tracer uptake for ganglia, which this present study aims to address.METHODS:Fifty consecutive patients with PC who received standard and late 68Ga-PSMA-11-PET/CT (by local protocol at 1.5 h "standard" and 2.5 h p.i. "late") underwent retrospective evaluation. All lesions with a tracer uptake above local background indicative for ganglia as well as PC lesions were analysed with regard to their maximum standardised uptake values (SUVmax) and localisation.RESULTS:Overall, 86 PSMA-positive ganglia were identified in 70% (n = 35) of the patients. Five ganglia exhibited PSMA avidity at late imaging only, and three at standard imaging only. A total of 66 lesions suggestive for PC were detected in 44 patients (88%), of which 45% (n = 30) were morphologically identified as lymph nodes (LN), the remainder being locally recurrent lesions or bone metastases. No solid organ metastases were present in our cohort. At late scanning, 73% of the LN exhibited an increase in SUVmax, whereas 65% of the ganglia exhibited a decreasing or stable SUVmax.CONCLUSION:Whereas the presence of increasing tracer uptake in potential PC lesions can provide additional data about the likelihood of malignancy, increasing SUVmax alone does not reliably differentiate between ganglia and PC lesions and is a potential diagnostic pitfall. We therefore recommend high-resolution CT to enable morphological characterisation of ganglia.

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II1 Apr 2018PD34-07 PSA FAILS TO PREDICT TREATMENT FAILURE IN FOCAL HIGH-INTENSITY FOCUSED ULTRASOUND THERAPY IN PROSTATE CANCER Philipp M. Huber, Naveed Afzal, Manit Arya, Silvan Boxler, Susan Charman, Andrew Cornaby, Tim Dudderidge, Mark Emberton, Stephanie Guillaumier, Richard J. Hindley, Lucas Leemann, Henry Lewi, Neil McCartan, Caroline M. Moore, Raj Nigam, Chris Ogden, Raj Persad, Karishma Shah, George N. Thalmann, Jaspal Virdi, Mathias Winkler, and Hashim U. Ahmed Philipp M. HuberPhilipp M. Huber More articles by this author , Naveed AfzalNaveed Afzal More articles by this author , Manit AryaManit Arya More articles by this author , Silvan BoxlerSilvan Boxler More articles by this author , Susan CharmanSusan Charman More articles by this author , Andrew CornabyAndrew Cornaby More articles by this author , Tim DudderidgeTim Dudderidge More articles by this author , Mark EmbertonMark Emberton More articles by this author , Stephanie GuillaumierStephanie Guillaumier More articles by this author , Richard J. HindleyRichard J. Hindley More articles by this author , Lucas LeemannLucas Leemann More articles by this author , Henry LewiHenry Lewi More articles by this author , Neil McCartanNeil McCartan More articles by this author , Caroline M. MooreCaroline M. Moore More articles by this author , Raj NigamRaj Nigam More articles by this author , Chris OgdenChris Ogden More articles by this author , Raj PersadRaj Persad More articles by this author , Karishma ShahKarishma Shah More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , Jaspal VirdiJaspal Virdi More articles by this author , Mathias WinklerMathias Winkler More articles by this author , and Hashim U. AhmedHashim U. Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1574AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine if PSA kinetics following focal high-intensity focused ultrasound (HIFU) for the treatment of non-metastatic prostate cancer can predict treatment failure. METHODS Retrospective analysis of our prospectively maintained HIFU (Sonablate 500) database, 598 patients were identified who underwent a focal HIFU (03/2007 to 11/2016). Follow-up with 3-monthly clinical visits and PSA testing in the first year. Thereafter PSA 6-monthly or annually at least. Routine and for-cause mpMRI followed by biopsies were offered. Treatment failure was defined by any secondary treatment (ADT/chemotherapy, cryotherapy, EBRT, RRP, or re-HIFU), metastasis from prostate cancer without further treatment, tumour recurrence with Gleason score ≥7 on prostate biopsy, or prostate cancer-related mortality. We evaluated a whole series of »nadir plus XX« thresholds (with XX from 0.1 to 2.0) for predicting failure using sensitivity and specificity, and Receiver Operating Characteristic (ROC) curve (statistics using R-language). RESULTS Median Gleason (range) 7 (6-9), in 80% Gleason ≥3+4=7. Tumours staged as localised T1c-T2c in 522/596 (88%) cases, 74/596 (12.4%) were radiological T3a/b. Baseline median (IQR) PSA was 7.80ng/ml (5.96-10.45) in those with failure and 6.77ng/ml (2.65-9.71) in those without failure. Using ASTRO criteria, sensitivity was 18.7%, specificity 68.3%. Evaluating other PSA nadir+XX thresholds, the highest sensitivity of 61.2% was shown for nadir+0.1ng/ml; the highest specificity of 59.1% for nadir+2.0ng/ml. All definitions of PSA failure incorporating nadir+XX thresholds led to significant false positives with the ROC curve shifted below the 50% line (Figure 1). CONCLUSIONS PSA kinetics following focal HIFU therapy occur differently following whole-gland therapy. Using any »nadir plus« definition leads to significant rates of false positives which might lead to unnecessary diagnostic procedures. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e658 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Philipp M. Huber More articles by this author Naveed Afzal More articles by this author Manit Arya More articles by this author Silvan Boxler More articles by this author Susan Charman More articles by this author Andrew Cornaby More articles by this author Tim Dudderidge More articles by this author Mark Emberton More articles by this author Stephanie Guillaumier More articles by this author Richard J. Hindley More articles by this author Lucas Leemann More articles by this author Henry Lewi More articles by this author Neil McCartan More articles by this author Caroline M. Moore More articles by this author Raj Nigam More articles by this author Chris Ogden More articles by this author Raj Persad More articles by this author Karishma Shah More articles by this author George N. Thalmann More articles by this author Jaspal Virdi More articles by this author Mathias Winkler More articles by this author Hashim U. Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinicians sometimes use decompression for secondary, low-risk cyst enucleation. The authors explored whether the decompression of dentigerous cysts associated with third molars is a reliable, long-term, definitive treatment option.The authors monitored 25 mandibular cysts associated with impacted third molars in adults after surgical decompression without the extraction of the related tooth for a mean (standard deviation) time of 37 (15) months (range, 12-71 months). The authors carefully evaluated the postoperative clinical situation and the extent of radiographic shrinkage.A minimal epithelial slit remained patent in all patients. All lacked clinical problems, had no need for further intervention, and exhibited persistent impaction of the teeth. The cyst reduction rate calculated on panoramic radiographs ranged from 63.4% to 98.8% (mean [standard deviation] 87.5% [10.6%]) and was statistically significant (P < .05). In 13 patients, the reduction rate was greater than 90%.Decompression triggered marked radiographic reductions of cysts when epithelial communication persisted. The situation stabilized after the first 6 through 8 months, and no further intervention was required.It is risky to enucleate cysts associated with impacted third molars and extract the molars. Clinicians can solve the problem in dental practice by using surgical decompression.

BackgroundA growing number of men undergo repeat biopsies prior to radical prostatectomy for prostate cancer. However, the long‐term impact of repeat biopsies on functional outcomes in this patient population remains unelucidated. Thus, we compared functional outcomes between patients who underwent single biopsy versus repeat biopsies before radical prostatectomy.MethodsFrom 1996 to 2015, 1015 consecutive patients underwent radical prostatectomy, and subsequently had urinary continence and erectile function assessed for >2 years follow‐up. One‐fourth of patients (275; 27%) had ≥2 biopsies before prostatectomy. Logistic regression models tested whether repeat biopsy before prostatectomy predicted continence or erectile function recovery.ResultsFor the overall cohort, continence rates were 84%, 92%, 96%, and 98% at 3, 6, 12, and 24 months, respectively. Repeat biopsy before prostatectomy was associated with lower continence rate at 3 months compared to single biopsy (P = 0.03); however, no significant differences were observed at 6, 12, or 24 months. In multivariable analyses adjusting for age, body mass index and diabetes/cardiovascular disease/smoking, the association between repeat biopsy and lower likelihood of continence at 3 months remained (odds ratio 0.67, 95% confidence interval 0.47‐0.97; P = 0.03). Overall erectile function recovery rates were 16%, 33%, 51%, and 55% at 3, 6, 12, and 24 months, respectively. No difference in erectile function recovery rates was seen at any time point for single biopsy versus repeat biopsy. In multivariable analyses, repeat biopsy was not predictive of erectile function recovery at any time point.ConclusionsRepeat biopsy before radical prostatectomy impairs early continence after surgery. However, erectile function recovery and mid‐term to long‐term continence are not affected. These data support the current trend towards active surveillance and delayed local treatment in patients with low‐ to intermediate‐risk prostate cancer.

BACKGROUND:Multiparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is an alternative to standard transrectal ultrasonography-guided biopsy for prostate-cancer detection in men with a raised prostate-specific antigen level who have not undergone biopsy. However, comparative evidence is limited. METHODS:In a multicenter, randomized, noninferiority trial, we assigned men with a clinical suspicion of prostate cancer who had not undergone biopsy previously to undergo MRI, with or without targeted biopsy, or standard transrectal ultrasonography-guided biopsy. Men in the MRI-targeted biopsy group underwent a targeted biopsy (without standard biopsy cores) if the MRI was suggestive of prostate cancer; men whose MRI results were not suggestive of prostate cancer were not offered biopsy. Standard biopsy was a 10-to-12-core, transrectal ultrasonography-guided biopsy. The primary outcome was the proportion of men who received a diagnosis of clinically significant cancer. Secondary outcomes included the proportion of men who received a diagnosis of clinically insignificant cancer. RESULTS:A total of 500 men underwent randomization. In the MRI-targeted biopsy group, 71 of 252 men (28%) had MRI results that were not suggestive of prostate cancer, so they did not undergo biopsy. Clinically significant cancer was detected in 95 men (38%) in the MRI-targeted biopsy group, as compared with 64 of 248 (26%) in the standard-biopsy group (adjusted difference, 12 percentage points; 95% confidence interval [CI], 4 to 20; P=0.005). MRI, with or without targeted biopsy, was noninferior to standard biopsy, and the 95% confidence interval indicated the superiority of this strategy over standard biopsy. Fewer men in the MRI-targeted biopsy group than in the standard-biopsy group received a diagnosis of clinically insignificant cancer (adjusted difference, -13 percentage points; 95% CI, -19 to -7; P<0.001). CONCLUSIONS:The use of risk assessment with MRI before biopsy and MRI-targeted biopsy was superior to standard transrectal ultrasonography-guided biopsy in men at clinical risk for prostate cancer who had not undergone biopsy previously. (Funded by the National Institute for Health Research and the European Association of Urology Research Foundation; PRECISION ClinicalTrials.gov number, NCT02380027 .).

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I1 Apr 2018MP30-10 HIFU DOSE ESCALATION LEADS TO FEWER RECURRENCES IN FOLLOWING FOCAL HIFU IN PROSTATE CANCER Philipp M. Huber, Naveed Afzal, Manit Arya, Silvan Boxler, Susan Charman, Andrew Cornaby, Tim Dudderidge, Mark Emberton, Stephanie Guillaumier, Richard J. Hindley, Lucas Leemann, Henry Lewi, Neil McCartan, Caroline M. Moore, Raj Nigam, Chris Ogden, Raj Persad, Karishma Shah, George N. Thalmann, Jaspal Virdi, Mathias Winkler, and Hashim U. Ahmed Philipp M. HuberPhilipp M. Huber More articles by this author , Naveed AfzalNaveed Afzal More articles by this author , Manit AryaManit Arya More articles by this author , Silvan BoxlerSilvan Boxler More articles by this author , Susan CharmanSusan Charman More articles by this author , Andrew CornabyAndrew Cornaby More articles by this author , Tim DudderidgeTim Dudderidge More articles by this author , Mark EmbertonMark Emberton More articles by this author , Stephanie GuillaumierStephanie Guillaumier More articles by this author , Richard J. HindleyRichard J. Hindley More articles by this author , Lucas LeemannLucas Leemann More articles by this author , Henry LewiHenry Lewi More articles by this author , Neil McCartanNeil McCartan More articles by this author , Caroline M. MooreCaroline M. Moore More articles by this author , Raj NigamRaj Nigam More articles by this author , Chris OgdenChris Ogden More articles by this author , Raj PersadRaj Persad More articles by this author , Karishma ShahKarishma Shah More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , Jaspal VirdiJaspal Virdi More articles by this author , Mathias WinklerMathias Winkler More articles by this author , and Hashim U. AhmedHashim U. Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.951AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine if delivering greater amounts of focused Ultrasound heat energy when treating non-metastatic prostate cancer using focal HIFU leads to lower recurrence rates. METHODS Based on the prospectively maintained HIFU (Sonablate 500) registry cases were identified who underwent a focal HIFU (03/2007 to 12/2016) with standard HIFU delivery or dose-escalated HIFU. In-field treamtent failure was defined by any secondary treatment (ADT/chemotherapy, cryotherapy, EBRT, RRP, or re-HIFU), metastasis from prostate cancer without further treatment, tumour recurrence with Gleason score ≥7 on prostate biopsy, or death from prostate cancer, respectively. 131 cases were treated with two, and 59 cases with three ablative zones respectively and could be used for a matched-pair analysis. Two major criteria were used for mandatory exact matching (baseline Gleason score and mpMRI-defined tumour volume). Other criteria (biopsy maximum cancer core length (MCCL), duration of clinical follow-up, and time to proof of recurrence) were also used and nearest matching accepted. 37 matched pairs were identified. Statistics by R-language. RESULTS In the standard HIFU and dose-escalated groups, respectively, PSA (IQR) was 7.18ng/ml (4.6-10.3) and 6.7ng/ml (5.37-8.5), mean prostate volume (range) was 46ml (17-103) and 52ml (19-121), mean tumour volume (range) in both groups were identical at 0.6ml (0.05-2.5). For the two groups, respectively, median biopsy results (IQR) for number of positive cores, MCCL (in cm), and maximal percentage of core were 6 (3-8) vs. 4 (3-5), 6 (4-9) vs. 5 (4-8), and 65 (40-80) vs. 50 (30-67). Gleason score (% of cases) was 3+3=6 in 2/37 (5%), 3+4 in 31/37 (84%), and 4+3 in 4/37 (11%). Median time elapsed until in-field failure was proven (IQR) was 13 month (11.5-24) compared to 11.5 month (9.5-13). Overall, in-field recurrence (%) was found in 11/37 (29.7%) in standard HIFU and 6/37 (16.2%) in dose-escalated HIFU (p=0.002). CONCLUSIONS Significantly higher rate of in-field treatment failure in focal HIFU using the standard HIFU protocol on the Sonablate 500 compared to a dose-escalation by delivering more energy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e378 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Philipp M. Huber More articles by this author Naveed Afzal More articles by this author Manit Arya More articles by this author Silvan Boxler More articles by this author Susan Charman More articles by this author Andrew Cornaby More articles by this author Tim Dudderidge More articles by this author Mark Emberton More articles by this author Stephanie Guillaumier More articles by this author Richard J. Hindley More articles by this author Lucas Leemann More articles by this author Henry Lewi More articles by this author Neil McCartan More articles by this author Caroline M. Moore More articles by this author Raj Nigam More articles by this author Chris Ogden More articles by this author Raj Persad More articles by this author Karishma Shah More articles by this author George N. Thalmann More articles by this author Jaspal Virdi More articles by this author Mathias Winkler More articles by this author Hashim U. Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2017PD15-12 THE IMPACT OF NERVE SPARING RADICAL PROSTATECTOMY ON ONCOLOGICAL AND FUNCTIONAL OUTCOMES IN PATIENTS WITH HIGH RISK PROSTATE CANCER: A RETROSPECTIVE LONG-TERM SINGLE CENTER STUDY Marc Alain Furrer, Tobias Gross, Daniel P. Nguyen, Silvan Boxler, Vera Genitsch, Fiona C. Burkhard, and George N. Thalmann Marc Alain FurrerMarc Alain Furrer More articles by this author , Tobias GrossTobias Gross More articles by this author , Daniel P. NguyenDaniel P. Nguyen More articles by this author , Silvan BoxlerSilvan Boxler More articles by this author , Vera GenitschVera Genitsch More articles by this author , Fiona C. BurkhardFiona C. Burkhard More articles by this author , and George N. ThalmannGeorge N. Thalmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3294AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Whether patients (pts) with high risk prostate cancer (HR PCa) should undergo radical prostatectomy (RP) remains a matter of debate. The aim of the present study was to assess functional and oncological outcomes following RP in pts with HR PCa. METHODS We evaluated 316 consecutive pts with HR PCa (according to the NCCN guidelines: pT3a tumor, a PSA level greater than 20 ng/mL, or a Gleason score between 8 and 10) who underwent RP and pelvic lymph node dissection from 1996 to 2015. Continence (CO) and potency (PO) were assessed at 3, 6, 12 and 24 months (mts). Pts who reported absence of erection sufficient for penetration prior to RP were excluded for evaluation of potency. Multivariable logistic regression models tested whether uni- and bilateral nerve sparing (NS) were a predictor of CO or PO at different time points after RP. Occurrence of local recurrence was prospectively entered into our database. For evaluation of positive surgical margins (PSM), pathology reports were retrospectively analyzed together with an uropathologist. RESULTS At 3, 6, 12, 24 mts, overall continence rates were 87%, 93%, 96% and 98%, respectively. Attempted NS RP was associated with higher continence rates at all time points compared to no NS RP (Fig). In multivariable analysis, NS was associated with a more than 2.5-fold higher probability of CO at 3 mts (OR 2.74, 95% CI 1.18-6.36, p=0.02). Overall potency rates were 15%, 31%, 47%, and 50% at 3, 6, 12, and 24 mts, respectively. Attempted nerve sparing RP was associated with higher potency rates at all time points compared to no NS RP (Fig). In multivariable analysis, NS was associated with a more than 6 to10-fold higher probability of PO at 6, 12 and 24 mts (p<0.0001, p=0.01 and p=0.001). The Clavien 30- and 90-day complication rate (p=0,3 and 0,2) as well as the percentage of major complications (p=0,2 and 0,1) were not higher in pts with attempted NS compared to pts without attempted NS. Likewise occurrence of PSM and local recurrence were not observed more frequently in pts with attempted NS. CONCLUSIONS Attempted NS in pts with HR PCa is associated with higher CO and PO rates after RP without compromising oncological outcome and occurrence of complications. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e287 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marc Alain Furrer More articles by this author Tobias Gross More articles by this author Daniel P. Nguyen More articles by this author Silvan Boxler More articles by this author Vera Genitsch More articles by this author Fiona C. Burkhard More articles by this author George N. Thalmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

To differentiate prostate cancer lesions with high and with low Gleason score by diffusion-weighted-MRI (DW-MRI).