Aaron Katz, Garden city, NY; Joseph Chin, London ON, Canada;. Duke Bahn, Ventura, CA; ... Christopher Ogden, Mark Emberton, London, United Kingdom.
Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013
e227
553
Patients with Gleason 3⫹3 on biopsy meeting criteria for AS n(%)
FIVE YEAR ONCOLOGICAL OUTCOMES FOLLOWING WHOLE-GLAND PRIMARY HIFU FROM THE UK INDEPENDENT HIFU REGISTRY
Positive predictive value
Negative predictive value
Area under curve
Sensitivity
Specificity
Positive predictive value
Negative predictive value
Area under curve
Organ-confined low grade cancer
Specificity
Insignificant cancer, updated definition
Sensitivity
Approach
THE JOURNAL OF UROLOGY姞
Tosoian 2011
46 (10.3)
0.17
0.94
0.28
0.89
0.55
0.14
0.95
0.52
0.75
0.55
Adamy 2011
157 (35.3)
0.45
0.76
0.21
0.91
0.60
0.43
0.79
0.43
0.79
0.61
Van den Bergh 2009
67 (15.1)
0.22
0.91
0.26
0.89
0.56
0.20
0.93
0.51
0.76
0.56
Whitson 2011
184 (41.4)
0.51
0.69
0.19
0.91
0.60
0.48
0.72
0.39
0.79
0.60
Soloway 2010
114 (25.6)
0.35
0.84
0.23
0.90
0.59
0.30
0.85
0.43
0.77
0.58
D’Amico 1998
286 (64.3)
0.56
0.69
0.21
0.92
0.63
0.58
0.75
0.47
0.83
0.67
Source of Funding: None
552 COMPLICATIONS OF SALVAGE CRYOSURGERY AFTER PRIMARY RADIATION THERAPY FOR PROSTATE CANCER: POOLED MULTICENTER ANALYSIS OF 798 PATIENTS Dan Leibovici*, Zerifin, Israel; Philippe Spiess, Tampa, FL; Aaron Katz, Garden city, NY; Joseph Chin, London ON, Canada; Duke Bahn, Ventura, CA; Jeffrey Cohen, Pittsburgh, PA; Katsuto Shinohara, San Francisco, CA; Mile Hernandez, Louis Pisters, Houston, TX INTRODUCTION AND OBJECTIVES: Salvage prostate cryosurgery (SPC) following primary radiation therapy has been associated with substantial morbidity. We aimed to report the frequency of SPC related complications and to identify risk factors and time trends. METHODS: Clinical data, procedure related data, and complications were recorded retrospectively on 798 patients who had undergone SPC in 6 medical centers. The occurrence of mild/moderate and severe urinary incontinence (UI), urine retention, bladder neck contracture, urethral sloughing, gross hematuria, perineal pain, and rectourethral fistula were documented after SPC. Univariate analysis addressed risk factors. RESULTS: Of the patients with complete data, the following complications were reported: mild to moderate UI in 26.4%, severe UI in 15.6%, urine retention in 15.1%, bladder neck contracture in 7.2%, urethral sloughing in 17.4%, hematuria in 9.8%, perineal pain in 10.6%, and fistula in 2.5% of the patients. The risk for any complication was associated with the year of salvage cryosurgery (odds ratio [OR] 0.46; 95%CI 0.31, 0.69 for 2000-2005 versus 1992-1995), the cryosurgery device generation (OR 0.05 95%CI 0.01, 0.24 for generation 3 versus 1) and the number of freeze/thaw cycles (OR 0.23, 95%CI 0.06,0.33 for 2 versus 1 cycle). The following complications became significantly less frequent between the years 1996 to 1999 and 2000 to 2005 versus 1992-1995: mild to moderate UI (32.5% to 20.5%); urine retention (24.1% to 9.2%); bladder neck contracture (10.0% to 2.3%); urethral sloughing (27.9% to 9.8%); pelvic/perineal pain (18.5% to 7.1%). There was a non-significant trend towards less frequent occurrence of fistula from 3.7% to 1.7%. Because the year of SPC and device generation were interdependent no multivariate analysis was performed. CONCLUSIONS: Although SPC is associated with substantial complications most complications have become less frequent in recent years. Source of Funding: None
Louise Dickinson*, Hashim Ahmed, Neil McCartan, Shraddha Weir, London, United Kingdom; Richard Hindley, Basingstoke, United Kingdom; Henry Lewi, Chelmsford, United Kingdom; Andrew Cornaby, Dorchester, United Kingdom; Senthil Nathan, London, United Kingdom; Raj Persad, Bristol, United Kingdom; Christopher Ogden, Mark Emberton, London, United Kingdom INTRODUCTION AND OBJECTIVES: High-intensity focused ultrasound (HIFU) can be used as a minimally-invasive treatment option to deliver whole-gland therapy for non-metastatic prostate cancer. We report medium term outcomes in men receiving primary wholegland HIFU (Sonablate® 500, Focus Surgery Inc, Indianapolis, IN, USA), from a multi-centre UK population collected within a national registry. METHODS: Patients treated with whole-gland HIFU (Sonablate® 500) for primary non-metastatic prostate cancer at 8 centres were entered into a UK independent registry. Biochemical disease free survival (BDFS) rates were evaluated using both Phoenix (PSA nadir⫹2ng/ml) and Stuttgart (PSA nadir⫹1.2ng/ml) criteria in those men with at least 6 months’ data following final HIFU treatment. Histological outcomes were reported in those men receiving postoperative biopsy. RESULTS: 570 consecutive men with non-metastatic prostate cancer received primary whole-gland HIFU (10/2004 and 06/2012). 23%, 34%, and 43% of men had low, intermediate and high risk cancer (D’Amico classification), respectively. Neo-adjuvant hormone treatment was received by 34% (193/570), with gland cytoreduction the purpose in 60% (116/193). The mean number of HIFU treatments was 1.3, with a median follow-up period of 57 months (IQR 38-73). Median PSA fell from 6.9ng/ml (range 0.1-74.7) at baseline to a nadir of 0.33ng/ml (range ⬍0.1 uˆ 30.4). 512 men had minimum of 6 months follow-up; BDFS was 84% (Phoenix) and 75% (Stuttgart). æFor cause’ biopsies were performed in 35% (197/570) of men after final HIFU treatment, with positive histology in 38% (75/197) (overall 15% biopsy positive 75⁄512). Adjuvant hormone ablation was received by 21% (119/570), and alternative salvage treatment in 10% (55/570) of men (external beam radiotherapy 84%, prostatectomy 9%, systemic chemotherapy 5%, cryotherapy 2%). CONCLUSIONS: Whole-gland HIFU is a therapeutic option for prostate cancer that is repeatable and delivered within a day case setting with favourable medium term disease-free outcomes. Source of Funding: None
554 INITIAL RESULTS OF MR GUIDED LASER FOCAL THERAPY FOR PROSTATE CANCER Uri Lindner*, Sean R.H. Davidson, Neil E. Fleshner, Anthonio Finelli, Alexandre R. Zlotta, Michael A.S. Jewett, Theodorus H. Van der Kwast, Mark R Gertner, Eugen Hlasny, Stuart A. McCluskey, Walter Kucharczyk, Masoom A.. Haider, John Trachtenberg, Toronto, Canada INTRODUCTION AND OBJECTIVES: Novel treatment strategies for prostate cancer (PCa) are being explored. We report the first comprehensive safety study and initial biological response to MRI guided and controlled laser focal ablation (MRgFLA) in men with localized PCa. METHODS: 38 men with organ confined PCa were treated in a phase I study between 2010 and 2012. MRgFLA was performed with the patient in the bore of a conventional MRI scanner. Laser fibers were placed within the prostate in proximity to the tumor via the perineum under MR imaging guidance. MR thermometry sequences provided real time information on the ablation. Initial response was assessed
