Mp73-08 focal ablative salvage therapy for radio-recurrent prostate cancer: a 10 year experience of oncological and safety outcomes in 276 patients

You have accessJournal of UrologyCME1 Apr 2023MP73-08 FOCAL ABLATIVE SALVAGE THERAPY FOR RADIO-RECURRENT PROSTATE CANCER: A 10 YEAR EXPERIENCE OF ONCOLOGICAL AND SAFETY OUTCOMES IN 276 PATIENTS Deepika Reddy, Taimur Shah, Emma Cullen, Mariana Bertoncelli Tanaka, Tim Dudderidge, Stuart McCracken, Raj Nigam, Jaspal Virdi, Iqbal Shergill, Clement Orczyk, Manit Arya, Caroline Moore, Mark Emberton, and Hashim Ahmed Deepika ReddyDeepika Reddy More articles by this author , Taimur ShahTaimur Shah More articles by this author , Emma CullenEmma Cullen More articles by this author , Mariana Bertoncelli TanakaMariana Bertoncelli Tanaka More articles by this author , Tim DudderidgeTim Dudderidge More articles by this author , Stuart McCrackenStuart McCracken More articles by this author , Raj NigamRaj Nigam More articles by this author , Jaspal VirdiJaspal Virdi More articles by this author , Iqbal ShergillIqbal Shergill More articles by this author , Clement OrczykClement Orczyk More articles by this author , Manit AryaManit Arya More articles by this author , Caroline MooreCaroline Moore More articles by this author , Mark EmbertonMark Emberton More articles by this author , and Hashim AhmedHashim Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Localised prostate cancer recurrence after radiotherapy is commonly managed with systemic therapy or watchful waiting due to significant complications and side-effects following salvage prostatectomy. Focal Ablative Salvage Therapy (FAST) using high intensity focussed ultrasound (HIFU) or cryotherapy might be an optimal approach to delay metastases and time to systemic therapy. METHODS: The HEAT and ICE registries included 292 patients undergoing FAST (June 2008-Feb 2022) (HIFU n=232, cryotherapy n=60). Primary outcome was metastases free survival. Secondary outcomes were 1) overall survival (OS), 2) ADT free survival (AFS) where ADT was prescribed due to biochemical recurrence (BCR, PSA nadir+2ng/ml), 3) retreatment free survival (RFS), and 4) composite Failure Free Survival (FFS) where a failure event was BCR, retreatment of any form, ADT, metastases or prostate cancer death was reported. 6-year Kaplan-Meier estimates (95% CI) and adverse events classified using Clavien-Dindo (CD) are reported. RESULTS: 276 (HIFU n=216, cryotherapy n=60) recorded follow-up outcomes at the time of analysis. 242, 25 and 9 previously had external radiotherapy, brachytherapy or combination, respectively. Patients underwent mpMRI and systematic +/- targeted biopsy, with PET imaging (choline or PSMA). Median (IQR) PSA at time of recurrence was 5.5ng/ml (3-8); stage T2 in 66%, T3a 13% and T3b 8%. Median (IQR) follow up time was 30 months (14-52).141/276 had reported composite treatment failure, 82 patients received at least 1 form of retreatment (25 focal ablation, 1 whole gland ablation, 2 salvage prostatectomy, 1 salvage radiotherapy, 51 ADT), 8 had metastases and 22 died. Metastases-free survival was 94% (86-97%) with median (IQR) 21 (13-44) months metastases (Figure 1). OS was 86% (76-92%), AFS 61% (47-72%), RFS 40% (29-52%), and composite FFS 21% (13-30%). Median (IQR) time from FAST to retreatment, ADT prescription and OS was 18 (12-33), 20 (13-39), and 53 (38-84) months, respectively.24 had an adverse event with 4 CD grade >/=3 events: 3 (1%) had fistula and 1 (0.4%) a urethral stricture. CONCLUSIONS: With a low rate of adverse events, FAST confers good metastases-free survival in this high risk cohort with the majority avoiding ADT due to biochemical recurrence. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1037 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepika Reddy More articles by this author Taimur Shah More articles by this author Emma Cullen More articles by this author Mariana Bertoncelli Tanaka More articles by this author Tim Dudderidge More articles by this author Stuart McCracken More articles by this author Raj Nigam More articles by this author Jaspal Virdi More articles by this author Iqbal Shergill More articles by this author Clement Orczyk More articles by this author Manit Arya More articles by this author Caroline Moore More articles by this author Mark Emberton More articles by this author Hashim Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...