Oncological outcomes of 356 patients undergoing salvage focal ablative HIFU or cryotherapy following radiation failure


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Deepika Reddy, Taimur Shah, Max Peters, Marieke van Son, Stephanie Guillaumier, Feargus Hosking-Jervis, Tim Dudderidge, Richard Hindley, Emr Amara, Stuart McCracken, Damian Greene, Raj Nigam, Jaspal Virdi, Clement Orczyk, Caroline Moore, Manit Arya, Mark Emberton, Hashim Ahmed

Abstract

Background

Patients that have previously failed radiotherapy for prostate cancer is usually limited to systemic therapy due to morbidity from salvage prostatectomy. We reviewed the outcomes following focal salvage ablative therapy with HIFU or cryotherapy within the UK’s HEAT and ICE registries.

Method

356 consecutive patients underwent focal ablative treatment after initial radiation treatment failure (28/1/2004-1/10/2019, 194 (54.5%) underwent HIFU (posterior recurrence) and 162 (45.5%) underwent cryotherapy (mostly anterior or T3b). Primary outcome was failure-free survival (FFS) defined as no systemic therapy, whole-gland treatment, metastases or prostate cancer-specific death. Secondary outcomes were adverse events and overall survival.

Results

Median (IQR) age was 69years (65-73) and PSA (IQR) was 4.0ng/ml (1-7-7.2). Overall median (IQR) follow-up was 41.3 months (21.4-58.5). Quadrant ablation was performed in 128 (36.0%), hemi-ablation performed in 64 (18.0%), hockey-stick in 5 (1.4%) and 159 (43.8%) had unknown ablative patterns.  Due to histological or MRI proven recurrence/residual disease, 31 (8.7%) underwent further focal salvage re-treatment.

FFS (95%CI) at 3 and 6 years were 81% (76-87%) and 75% (68-83%) respectively (figure 1a). Median (IQR) time to failure was 15.5 months (19.7).  Overall survival (95%CI) at 3 and 6 years were 97% (95-100%) and 88% (81-96%) respectively (figure1b). Prostate-specific mortality was 2.8%. Overall 1 (0.3%) patient was managed for fistula formation, 16 (4.5%) were treated for UTIs.

Conclusion

Salvage focal ablative therapy for radio-recurrent prostate cancer is safe and provides good short to medium-term oncological control. The FORECAST study is awaited to further determine oncological outcomes in this cohort.

Impact statement

Focal ablative salvage treatment is safe and effective in the medium term, and may prove to be a suitable alternative to radical prostatectomy or systemic therapy for patients with radio-recurrent prostate cancer.