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Light A, Mayor N, Cullen E, Kirkham A, Padhani AR, Arya M, Bomers JGR, Dudderidge T, Ehdaie B, Freeman A, Guillaumier S, Hindley R, Lakhani A, Pendse D, Punwani S, Rastinehad AR, Rouvière O, Sanchez-Salas R, Schoots IG, Sokhi HK, Tam H, Tempany CM, Valerio M, Verma S, Villeirs G, van der Meulen J, Ahmed HU, Shah TT. The Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET): A Systematic Review and International Consensus Recommendations. Eur Urol 2024; 85:466-482. [PMID: 38519280 DOI: 10.1016/j.eururo.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/29/2023] [Accepted: 02/04/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Magnetic resonance imaging (MRI) can detect recurrences after focal therapy for prostate cancer but there is no robust guidance regarding its use. Our objective was to produce consensus recommendations on MRI acquisition, interpretation, and reporting after focal therapy. METHODS A systematic review was performed in July 2022 to develop consensus statements. A two-round consensus exercise was then performed, with a consensus meeting in January 2023, during which 329 statements were scored by 23 panellists from Europe and North America spanning urology, radiology, and pathology with experience across eight focal therapy modalities. Using RAND Corporation/University of California-Los Angeles methodology, the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) were based on consensus for statements scored with agreement or disagreement. KEY FINDINGS AND LIMITATIONS In total, 73 studies were included in the review. All 20 studies (100%) reporting suspicious imaging features cited focal contrast enhancement as suspicious for cancer recurrence. Of 31 studies reporting MRI assessment criteria, the Prostate Imaging-Reporting and Data System (PI-RADS) score was the scheme used most often (20 studies; 65%), followed by a 5-point Likert score (six studies; 19%). For the consensus exercise, consensus for statements scored with agreement or disagreement increased from 227 of 295 statements (76.9%) in round one to 270 of 329 statements (82.1%) in round two. Key recommendations include performing routine MRI at 12 mo using a multiparametric protocol compliant with PI-RADS version 2.1 standards. PI-RADS category scores for assessing recurrence within the ablation zone should be avoided. An alternative 5-point scoring system is presented that includes a major dynamic contrast enhancement (DCE) sequence and joint minor diffusion-weighted imaging and T2-weighted sequences. For the DCE sequence, focal nodular strong early enhancement was the most suspicious imaging finding. A structured minimum reporting data set and minimum reporting standards for studies detailing MRI data after focal therapy are presented. CONCLUSIONS AND CLINICAL IMPLICATIONS The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting. PATIENT SUMMARY Magnetic resonance imaging (MRI) scans can detect recurrent of prostate cancer after focal treatments, but there is a lack of guidance on MRI use for this purpose. We report new expert recommendations that may improve practice.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nikhil Mayor
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Cullen
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Manit Arya
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joyce G R Bomers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Behfar Ehdaie
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Richard Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Amish Lakhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Douglas Pendse
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | | | - Olivier Rouvière
- Department of Vascular and Urinary Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine, Université de Lyon, Lyon, France
| | | | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Heminder K Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Henry Tam
- Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Massimo Valerio
- Department of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Light A, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Williams NR, Emara A, Haroon A, Latifoltojar A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley RG, Virdi J, Arya M, Payne H, Mitra AV, Bomanji J, Winkler M, Horan G, Moore CM, Emberton M, Punwani S, Ahmed HU, Shah TT. The Role of Multiparametric MRI and MRI-targeted Biopsy in the Diagnosis of Radiorecurrent Prostate Cancer: An Analysis from the FORECAST Trial. Eur Urol 2024; 85:35-46. [PMID: 37778954 DOI: 10.1016/j.eururo.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/01/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The role of multiparametric magnetic resonance imaging (MRI) for detecting recurrent prostate cancer after radiotherapy is unclear. OBJECTIVE To evaluate MRI and MRI-targeted biopsies for detecting intraprostatic cancer recurrence and planning for salvage focal ablation. DESIGN, SETTING, AND PARTICIPANTS FOcal RECurrent Assessment and Salvage Treatment (FORECAST; NCT01883128) was a prospective cohort diagnostic study that recruited 181 patients with suspected radiorecurrence at six UK centres (2014 to 2018); 144 were included here. INTERVENTION All patients underwent MRI with 5 mm transperineal template mapping biopsies; 84 had additional MRI-targeted biopsies. MRI scans with Likert scores of 3 to 5 were deemed suspicious. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS First, the diagnostic accuracy of MRI was calculated. Second, the pathological characteristics of MRI-detected and MRI-undetected tumours were compared using the Wilcoxon rank sum test and chi-square test for trend. Third, four biopsy strategies involving an MRI-targeted biopsy alone and with systematic biopsies of one to two other quadrants were studied. Fisher's exact test was used to compare MRI-targeted biopsy alone with the best other strategy for the number of patients with missed cancer and the number of patients with cancer harbouring additional tumours in unsampled quadrants. Analyses focused primarily on detecting cancer of any grade or length. Last, eligibility for focal therapy was evaluated for men with localised (≤T3bN0M0) radiorecurrent disease. RESULTS AND LIMITATIONS Of 144 patients, 111 (77%) had cancer detected on biopsy. MRI sensitivity and specificity at the patient level were 0.95 (95% confidence interval [CI] 0.92 to 0.99) and 0.21 (95% CI 0.07 to 0.35), respectively. At the prostate quadrant level, 258/576 (45%) quadrants had cancer detected on biopsy. Sensitivity and specificity were 0.66 (95% CI 0.59 to 0.73) and 0.54 (95% CI 0.46 to 0.62), respectively. At the quadrant level, compared with MRI-undetected tumours, MRI-detected tumours had longer maximum cancer core length (median difference 3 mm [7 vs 4 mm]; 95% CI 1 to 4 mm, p < 0.001) and a higher grade group (p = 0.002). Of the 84 men who also underwent an MRI-targeted biopsy, 73 (87%) had recurrent cancer diagnosed. Performing an MRI-targeted biopsy alone missed cancer in 5/73 patients (7%; 95% CI 3 to 15%); with additional systematic sampling of the other ipsilateral and contralateral posterior quadrants (strategy 4), 2/73 patients (3%; 95% CI 0 to 10%) would have had cancer missed (difference 4%; 95% CI -3 to 11%, p = 0.4). If an MRI-targeted biopsy alone was performed, 43/73 (59%; 95% CI 47 to 69%) patients with cancer would have harboured undetected additional tumours in unsampled quadrants. This reduced but only to 7/73 patients (10%; 95% CI 4 to 19%) with strategy 4 (difference 49%; 95% CI 36 to 62%, p < 0.0001). Of 73 patients, 43 (59%; 95% CI 47 to 69%) had localised radiorecurrent cancer suitable for a form of focal ablation. CONCLUSIONS For patients with recurrent prostate cancer after radiotherapy, MRI and MRI-targeted biopsy, with or without perilesional sampling, will diagnose cancer in the majority where present. MRI-undetected cancers, defined as Likert scores of 1 to 2, were found to be smaller and of lower grade. However, if salvage focal ablation is planned, an MRI-targeted biopsy alone is insufficient for prostate mapping; approximately three of five patients with recurrent cancer found on an MRI-targeted biopsy alone harboured further tumours in unsampled quadrants. Systematic sampling of the whole gland should be considered in addition to an MRI-targeted biopsy to capture both MRI-detected and MRI-undetected disease. PATIENT SUMMARY After radiotherapy, magnetic resonance imaging (MRI) is accurate for detecting recurrent prostate cancer, with missed cancer being smaller and of lower grade. Targeting a biopsy to suspicious areas on MRI results in a diagnosis of cancer in most patients. However, for every five men who have recurrent cancer, this targeted approach would miss cancers elsewhere in the prostate in three of these men. If further focal treatment of the prostate is planned, random biopsies covering the whole prostate in addition to targeted biopsies should be considered so that tumours are not missed.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Abi Kanthabalan
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Marjorie Otieno
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Sola Adeleke
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris Brew-Graves
- Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Norman R Williams
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Athar Haroon
- Department of Nuclear Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arash Latifoltojar
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Harbir Sidhu
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ashok Nikapota
- Sussex Cancer Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Heather Payne
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Anita V Mitra
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
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Light A, Peters M, Reddy D, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Williams NR, Emara A, Haroon A, Latifoltojar A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley RG, Virdi J, Arya M, Payne H, Mitra AV, Bomanji J, Winkler M, Horan G, Moore C, Emberton M, Punwani S, Ahmed HU, Shah TT. External validation of a risk model predicting failure of salvage focal ablation for prostate cancer. BJU Int 2023; 132:520-530. [PMID: 37385981 PMCID: PMC10615865 DOI: 10.1111/bju.16102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVES To externally validate a published model predicting failure within 2 years after salvage focal ablation in men with localised radiorecurrent prostate cancer using a prospective, UK multicentre dataset. PATIENTS AND METHODS Patients with biopsy-confirmed ≤T3bN0M0 cancer after previous external beam radiotherapy or brachytherapy were included from the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial (NCT01883128; 2014-2018; six centres), and from the high-intensity focussed ultrasound (HIFU) Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) UK-based registries (2006-2022; nine centres). Eligible patients underwent either salvage focal HIFU or cryotherapy, with the choice based predominantly on anatomical factors. Per the original multivariable Cox regression model, the predicted outcome was a composite failure outcome. Model performance was assessed at 2 years post-salvage with discrimination (concordance index [C-index]), calibration (calibration curve and slope), and decision curve analysis. For the latter, two clinically-reasonable risk threshold ranges of 0.14-0.52 and 0.26-0.36 were considered, corresponding to previously published pooled 2-year recurrence-free survival rates for salvage local treatments. RESULTS A total of 168 patients were included, of whom 84/168 (50%) experienced the primary outcome in all follow-ups, and 72/168 (43%) within 2 years. The C-index was 0.65 (95% confidence interval 0.58-0.71). On graphical inspection, there was close agreement between predicted and observed failure. The calibration slope was 1.01. In decision curve analysis, there was incremental net benefit vs a 'treat all' strategy at risk thresholds of ≥0.23. The net benefit was therefore higher across the majority of the 0.14-0.52 risk threshold range, and all of the 0.26-0.36 range. CONCLUSION In external validation using prospective, multicentre data, this model demonstrated modest discrimination but good calibration and clinical utility for predicting failure of salvage focal ablation within 2 years. This model could be reasonably used to improve selection of appropriate treatment candidates for salvage focal ablation, and its use should be considered when discussing salvage options with patients. Further validation in larger, international cohorts with longer follow-up is recommended.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | - Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Deepika Reddy
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | - Abi Kanthabalan
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Marjorie Otieno
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Sola Adeleke
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Francesco Giganti
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris Brew-Graves
- Division of Medicine, Faculty of Medicine, University College London, UK
| | - Norman R. Williams
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Athar Haroon
- Department of Nuclear Medicine, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arash Latifoltojar
- Division of Medicine, Faculty of Medicine, University College London, UK
- Department of Radiology, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Harbir Sidhu
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, Faculty of Medicine, University College London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ashok Nikapota
- Sussex Cancer Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard G. Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | - Heather Payne
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Anita V. Mitra
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, King's Lynn, UK
| | - Caroline Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, Faculty of Medicine, University College London, UK
| | - Hashim U. Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Taimur T. Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
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Habashy D, Reddy D, Peters M, Shah TT, van Son M, van Rossum PSN, Tanaka MB, Cullen E, Engle R, McCracken S, Greene D, Hindley RG, Emara A, Nigam R, Orczyk C, Shergill I, Persad R, Virdi J, Moore CM, Arya M, Winkler M, Emberton M, Ahmed HU, Dudderidge T. Evaluation of Outcomes Following Focal Ablative Therapy for Treatment of Localized Clinically Significant Prostate Cancer in Patients >70 Years: A Multi-institute, Multi-energy 15-Year Experience. J Urol 2023; 210:108-116. [PMID: 37014172 DOI: 10.1097/ju.0000000000003443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE In older patients who do not wish to undergo watchful waiting, focal therapy could be an alternative to the more morbid radical treatment. We evaluated the role of focal therapy in patients 70 years and older as an alternative management modality. MATERIALS AND METHODS A total of 649 patients across 11 UK sites receiving focal high-intensity focused ultrasound or cryotherapy between June 2006 and July 2020 reported within the UK-based HEAT (HIFU Evaluation and Assessment of Treatment) and ICE (International Cryotherapy Evaluation) registries were evaluated. Primary outcome was failure-free survival, defined by need for more than 1 focal reablation, progression to radical treatment, development of metastases, need for systemic treatment, or prostate cancer-specific death. This was compared to the failure-free survival in patients undergoing radical treatment via a propensity score weighted analysis. RESULTS Median age was 74 years (IQR: 72, 77) and median follow-up 24 months (IQR: 12, 41). Sixty percent had intermediate-risk disease and 35% high-risk disease. A total of 113 patients (17%) required further treatment. Sixteen had radical treatment and 44 required systemic treatment. Failure-free survival was 82% (95% CI: 76%-87%) at 5 years. Comparing patients who had radical therapy to those who had focal therapy, 5-year failure-free survival was 96% (95% CI: 93%-100%) and 82% (95% CI: 75%-91%) respectively (P < .001). Ninety-three percent of those in the radical treatment arm had received radiotherapy as their primary treatment with its associated use of androgen deprivation therapy, thereby leading to potential overestimation of treatment success in the radical treatment arm, especially given the similar metastases-free and overall survival rates seen. CONCLUSIONS We propose focal therapy to be an effective management option for the older or comorbid patient who is unsuitable for or not willing to undergo radical treatment.
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Affiliation(s)
- David Habashy
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Max Peters
- Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Marieke van Son
- Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands
| | - Peter S N van Rossum
- Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands
| | | | - Emma Cullen
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ryan Engle
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, City Hospital Foundation Trust, Sunderland, United Kingdom
| | - Damian Greene
- Department of Urology, Spire Hospital, Washington, United Kingdom
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom
- BMI The Hampshire Clinic, Basingstoke, United Kingdom
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom
- Ain Shams University Hospitals, Cairo, Egypt
| | - Raj Nigam
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
- BMI Mount Alvernia Hospital, Guildford, United Kingdom
| | - Clement Orczyk
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, United Kingdom
| | - Iqbal Shergill
- Department of Urology, Wrexham Maelor Hospital, Wrexham, United Kingdom
| | - Raj Persad
- North Bristol NHS Trust, Westbury on Trym, Bristol, United Kingdom
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom
| | - Caroline M Moore
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, United Kingdom
- Princess Grace Hospital, London, United Kingdom
- King Edward VII Hospital, London, United Kingdom
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, United Kingdom
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mark Emberton
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, United Kingdom
- Princess Grace Hospital, London, United Kingdom
- King Edward VII Hospital, London, United Kingdom
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- King Edward VII Hospital, London, United Kingdom
- Cromwell Hospital, London, United Kingdom
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Shah TT, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Williams NR, Grierson J, Miah H, Emara A, Haroon A, Latifoltojar A, Sidhu H, Clemente J, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley RG, Virdi J, Arya M, Payne H, Mitra A, Bomanji J, Winkler M, Horan G, Moore CM, Emberton M, Punwani S, Ahmed HU. Corrigendum to "Magnetic Resonance Imaging and targeted biopsies compared to transperineal mapping biopsies prior to salvage focal therapy/ablation in localised and metastatic recurrent prostate cancer after radiotherapy. Primary Outcomes from the FORECAST Trial" [Eur Urol 2022;81(6):598-605]. Eur Urol 2023; 83:e117-e118. [PMID: 36681537 DOI: 10.1016/j.eururo.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK.
| | - Abi Kanthabalan
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Marjorie Otieno
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Sola Adeleke
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Oncology, King's College London, London, UK; Department of Oncology, Maidstone and Tunbridge Wells Hospital, Maidstone, UK; School of Cancer & Pharmaceutical Sciences, King's College London, Queen Square, London WC1N 3BG, UK; High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Francesco Giganti
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris Brew-Graves
- Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Norman R Williams
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Jack Grierson
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Haroon Miah
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK; Urology Department, Ain Shams University Hospitals, Cairo, Egypt
| | - Athar Haroon
- Department of Nuclear Medicine, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arash Latifoltojar
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | - Harbir Sidhu
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Joey Clemente
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ashok Nikapota
- Sussex Cancer Centre. Royal Sussex County Hospital, Brighton, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Heather Payne
- Department of Oncology, University College London and University College London Hospital NHS Foundation Trust, London, UK
| | - Anita Mitra
- Department of Oncology, University College London and University College London Hospital NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, Kings Lynn, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Reddy D, van Son M, Peters M, Bertoncelli Tanaka M, Dudderidge T, Cullen E, Ho CLT, Hindley RG, Emara A, McCracken S, Orczyk C, Shergill I, Mangar S, Nigam R, Virdi J, Moore CM, Arya M, Shah TT, Winkler M, Emberton M, Falconer A, Belsey J, Ahmed HU. Focal therapy versus radical prostatectomy and external beam radiotherapy as primary treatment options for non-metastatic prostate cancer: results of a cost-effectiveness analysis. J Med Econ 2023; 26:1099-1107. [PMID: 37656223 DOI: 10.1080/13696998.2023.2251849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
AIMS Focal therapy treats individual areas of tumour in non-metastatic prostate cancer in patients unsuitable for active surveillance. The aim of this work was to evaluate the cost-effectiveness of focal therapy versus prostatectomy and external beam radiotherapy (EBRT). MATERIALS AND METHODS A Markov cohort health state transition model with four health states (stable disease, local recurrence, metastatic disease and death) was created, evaluating costs and utilities over a 10-year time horizon for patients diagnosed with non-metastatic prostate cancer. National Health Service (NHS) for England perspective was used, based on direct healthcare costs. Clinical transition probabilities were derived from prostate cancer registries in patients undergoing radical prostatectomy, EBRT and focal therapy using cryotherapy (Boston Scientific) or high-intensity focused ultrasound (HIFU) (Sonablate). Propensity score matching was used to ensure that at-risk populations were comparable. Variables included age, prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group, maximum cancer core length (mm), T-stage and year of treatment. RESULTS Focal therapy was associated with a lower overall cost and higher quality-adjusted life year (QALY) gains than either prostatectomy or EBRT, dominating both treatment strategies. Positive incremental net monetary benefit (NMB) values confirm focal therapy as cost-effective versus the alternatives at a willingness to pay (WTP) threshold of £30,000/QALY. One-way deterministic sensitivity analyses revealed consistent results. LIMITATIONS Data used to calculate the transition probabilities were derived from a limited number of hospitals meaning that other potential treatment options were excluded. Limited data were available on later outcomes and none on quality of life data, therefore, literature-based estimates were used. CONCLUSIONS Cost-effectiveness modelling demonstrates use of focal therapy (cryotherapy or HIFU) is associated with greater QALY gains at a lower overall cost than either radical prostatectomy or EBRT, representing good value for money in the NHS.
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Affiliation(s)
| | | | - Max Peters
- Amsterdam University Medical Centers, The Netherlands
| | | | - Tim Dudderidge
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | | | - Richard G Hindley
- Hampshire Hospitals NHS Foundation Trust, UK
- BMI The Hampshire Clinic, Basingstoke, UK
| | - Amr Emara
- Hampshire Hospitals NHS Foundation Trust, UK
| | | | - Clement Orczyk
- University College London NHS Foundation Trust, London, UK
| | | | | | - Raj Nigam
- Royal Surrey NHS Foundation Trust, Guildford, UK
- BMI Mount Alvernia Hospital, Guildford, UK
| | - Jaspal Virdi
- Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Caroline M Moore
- University College London NHS Foundation Trust, London, UK
- Princess Grace Hospital, London, UK
- King Edward VII Hospital, London, UK
| | - Manit Arya
- Imperial College NHS Healthcare Trust, London, UK
- University College London NHS Foundation Trust, London, UK
| | - Taimur T Shah
- Imperial College, London, UK
- Imperial College NHS Healthcare Trust, London, UK
| | - Mathias Winkler
- Imperial College, London, UK
- Imperial College NHS Healthcare Trust, London, UK
| | - Mark Emberton
- University College London NHS Foundation Trust, London, UK
- Princess Grace Hospital, London, UK
- King Edward VII Hospital, London, UK
| | | | | | - Hashim U Ahmed
- Imperial College, London, UK
- Imperial College NHS Healthcare Trust, London, UK
- King Edward VII Hospital, London, UK
- Department of Urology, Cromwell Hospital, London, UK
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7
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Shah TT, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Williams NR, Grierson J, Miah H, Emara A, Haroon A, Latifoltojar A, Sidhu H, Clemente J, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley RG, Virdi J, Arya M, Payne H, Mitra A, Bomanji J, Winkler M, Horan G, Moore CM, Emberton M, Punwani S, Ahmed HU. Magnetic Resonance Imaging and Targeted Biopsies Compared to Transperineal Mapping Biopsies Before Focal Ablation in Localised and Metastatic Recurrent Prostate Cancer After Radiotherapy. Eur Urol 2022; 81:598-605. [PMID: 35370021 PMCID: PMC9156577 DOI: 10.1016/j.eururo.2022.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/30/2022] [Accepted: 02/23/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recurrent prostate cancer after radiotherapy occurs in one in five patients. The efficacy of prostate magnetic resonance imaging (MRI) in recurrent cancer has not been established. Furthermore, high-quality data on new minimally invasive salvage focal ablative treatments are needed. OBJECTIVE To evaluate the role of prostate MRI in detection of prostate cancer recurring after radiotherapy and the role of salvage focal ablation in treating recurrent disease. DESIGN, SETTING, AND PARTICIPANTS The FORECAST trial was both a paired-cohort diagnostic study evaluating prostate multiparametric MRI (mpMRI) and MRI-targeted biopsies in the detection of recurrent cancer and a cohort study evaluating focal ablation at six UK centres. A total of 181 patients were recruited, with 155 included in the MRI analysis and 93 in the focal ablation analysis. INTERVENTION Patients underwent choline positron emission tomography/computed tomography and a bone scan, followed by prostate mpMRI and MRI-targeted and transperineal template-mapping (TTPM) biopsies. MRI was reported blind to other tests. Those eligible underwent subsequent focal ablation. An amendment in December 2014 permitted focal ablation in patients with metastases. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcomes were the sensitivity of MRI and MRI-targeted biopsies for cancer detection, and urinary incontinence after focal ablation. A key secondary outcome was progression-free survival (PFS). RESULTS AND LIMITATIONS Staging whole-body imaging revealed localised cancer in 128 patients (71%), with involvement of pelvic nodes only in 13 (7%) and metastases in 38 (21%). The sensitivity of MRI-targeted biopsy was 92% (95% confidence interval [CI] 83-97%). The specificity and positive and negative predictive values were 75% (95% CI 45-92%), 94% (95% CI 86-98%), and 65% (95% CI 38-86%), respectively. Four cancer (6%) were missed by TTPM biopsy and six (8%) were missed by MRI-targeted biopsy. The overall MRI sensitivity for detection of any cancer was 94% (95% CI 88-98%). The specificity and positive and negative predictive values were 18% (95% CI 7-35%), 80% (95% CI 73-87%), and 46% (95% CI 19-75%), respectively. Among 93 patients undergoing focal ablation, urinary incontinence occurred in 15 (16%) and five (5%) had a grade ≥3 adverse event, with no rectal injuries. Median follow-up was 27 mo (interquartile range 18-36); overall PFS was 66% (interquartile range 54-75%) at 24 mo. CONCLUSIONS Patients should undergo prostate MRI with both systematic and targeted biopsies to optimise cancer detection. Focal ablation for areas of intraprostatic recurrence preserves continence in the majority, with good early cancer control. PATIENT SUMMARY We investigated the role of magnetic resonance imaging (MRI) scans of the prostate and MRI-targeted biopsies in outcomes after cancer-targeted high-intensity ultrasound or cryotherapy in patients with recurrent cancer after radiotherapy. Our findings show that these patients should undergo prostate MRI with both systematic and targeted biopsies and then ablative treatment focused on areas of recurrent cancer to preserve their quality of life. This trial is registered at ClinicalTrials.gov as NCT01883128.
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Affiliation(s)
- Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK.
| | - Abi Kanthabalan
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Marjorie Otieno
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Sola Adeleke
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Oncology, King's College London, London, UK; Department of Oncology, Maidstone and Tunbridge Wells Hospital, Maidstone, UK; School of Cancer & Pharmaceutical Sciences, King's College London, Queen Square, London WC1N 3BG, UK; High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Francesco Giganti
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris Brew-Graves
- Division of Medicine, Faculty of Medicine, University College London, London, UK
| | - Norman R Williams
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Jack Grierson
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Haroon Miah
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK; Urology Department, Ain Shams University Hospitals, Cairo, Egypt
| | - Athar Haroon
- Department of Nuclear Medicine, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arash Latifoltojar
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | - Harbir Sidhu
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Joey Clemente
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ashok Nikapota
- Sussex Cancer Centre. Royal Sussex County Hospital, Brighton, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Heather Payne
- Department of Oncology, University College London and University College London Hospital NHS Foundation Trust, London, UK
| | - Anita Mitra
- Department of Oncology, University College London and University College London Hospital NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, Kings Lynn, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Division of Medicine, Faculty of Medicine, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Reddy D, Dudderidge T, Shah T, McCracken S, Arya M, Fiorentino F, Day E, Prevost A, Emberton M, Staffurth J, Sandhu S, Hindley R, Arumainayagam N, Sydes MR, Khoo V, Winkler M, Ahmed HU. Comparative healthcare research outcomes of novel Surgery in prostate cancer (IP4-CHRONOS): Pilot RCT assessing feasibility of randomization for focal therapy in localized prostate cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5086 Background: Randomised comparative data is lacking for focal therapy in localised prostate cancer. Imperial Prostate 4 CHRONOS (IP4- CHRONOS) is an RCT designed to reflect patient and physician equipoise to maximise acceptance to randomisation. Methods: Patients and physicians could opt for CHRONOS-A or CHRONOS-B. CHRONOS-A randomised between focal therapy (HIFU/cryotherapy) and radical therapy (radiation/prostatectomy). Using a multi-arm-multistage design, CHRONOS-B randomised between focal and focal combined with neoadjuvant medication (3 months of either finasteride or bicalutamide). We report the pilot phase outcomes on feasibility of randomisation. IP4-CHRONOS had ethics committee approval and was registered (ISRCTN17796995). Results: Due to impact of COVID-19, the target for CHRONOS-A was modified from 60 to 36; 36 patients were randomised over 24 months from 7 sites (Nov/2019-Nov/2021). CHRONOS-B randomised 64 patients over 14 months across 6 sites (Dec/2019-Feb/2021). Median (IQR) age and PSA (ng/ml) for CHRONOS-A were 69 (65-72) years and 6 (5-7) and for 66 (60.5-70) years and 6 (4-7) for CHRONOS-B, respectively. 34/36 (94%) and 60/64 (94%) had ISUP Grade Group > / = 2, respectively. 4/18 (22%) randomised to radical in CHRONOS-A withdrew consent; 1/22 (5%) randomised to focal withdrew. In CHRONOS-B, only 1/21 (5%) randomised to focal alone, and another randomised to focal with neoadjuvant bicalutamide withdrew. A qualitative recruitment intervention partially improved accrual to CHRONOS-A. Conclusions: IP4-CHRONOS evaluated patient and physician equipoise regarding focal therapy. Randomising between focal and radical therapy is not feasible due to strong patient preferences. A multi-arm, multi-stage RCT investigating the role of neoadjuvant agents combined with focal therapy is feasible. Clinical trial information: 17796995.
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Affiliation(s)
| | - Tim Dudderidge
- University Hospital Southampton, Southampton, United Kingdom
| | | | | | - Manit Arya
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Emily Day
- Imperial College London, London, United Kingdom
| | | | | | | | | | | | - Nim Arumainayagam
- Department of Urology, Ashford and St Peters Hospitals, London, United Kingdom
| | | | | | - Mathias Winkler
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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9
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Reddy D, Peters M, Shah T, van Son M, Bertoncelli MT, Huber P, Lomas D, Rakauskas A, Miah S, Eldred-Evans D, Guillaumier S, Hosking-Jervis F, Engle R, Dudderidge T, Hindley R, Emara A, Nigam R, McCartan N, Valerio M, Afzal N, Lewi H, Orczyk C, Ogden C, Shergill I, Persad R, Virdi J, McCracken S, Greene D, Moore C, Arya M, Winkler M, Emberton M, Ahmed H. MP55-06 FOCAL ABLATIVE SALVAGE THERAPY FOR RADIO-RECURRENT PROSTATE CANCER: 6 YEAR ONCOLOGICAL AND SAFETY OUTCOMES. J Urol 2022. [DOI: 10.1097/ju.0000000000002634.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Reddy D, Peters M, Shah T, Van Son M, Bertoncelli Tanaka M, Huber P, Lomas D, Rakauskas A, Miah S, Eldred-Evans D, Hosking-Jervis F, Engle R, Dudderidge T, Mccracken S, Greene D, Nigam R, Mccartan N, Valerio M, Orczyk C, Virdi J, Arya M, Ahmed H. Primary focal cryotherapy for non-metastatic prostate cancer: Update from the UK ICE registry. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sharun K, Jambagi K, Arya M, Aakanksha, Chaithra SN, Patel PK, Dixit SK, Dhama K. Clinical Applications of Substance P (Neurokinin-1 Receptor) Antagonist in Canine Medicine. Arch Razi Inst 2021; 76:1175-1182. [PMID: 35355772 PMCID: PMC8934081 DOI: 10.22092/ari.2021.356171.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/09/2021] [Indexed: 01/24/2023]
Abstract
Substance P binds to the Neurokinin-1 (NK-1) receptors found in the emetic center of the central nervous system (CNS) to induce emesis. Maropitant is a selective NK-1 receptor antagonist that inhibits the binding of substance P to NK-1 receptors and is commonly used to prevent and treat vomiting in dogs. This review study aimed to discuss and analyze the therapeutic potential of substance P (Neurokinin-1 receptor) antagonist with a particular focus on the drug maropitant in canine medicine. A systematic literature review was performed to identify the existing literature on the subject during the past 20 years (2001-2021) using such databases as ScienceDirect, PubMed, Scopus, and Google Scholar. The initial search identified 173 articles; however, 41 articles were selected for further analysis, based on the specific inclusion and exclusion criteria. Studies have already confirmed the role of substance P and NK-1 receptors in central pain processing, intestinal smooth muscle contraction, vasodilation, and neurogenic inflammation. Maropitant is one of the most effective veterinary antiemetic drugs that work well against peripheral and central stimuli that trigger the vomiting center. It has been already demonstrated that the therapeutic efficacy of maropitant for managing acute vomiting in dogs is associated with pancreatitis, gastritis, and parvoviral enteritis. It can also prevent and treat chemotherapy-induced emesis and delay the signs of nausea and adverse gastrointestinal effects. Regarding the broad-spectrum antiemetic activity of maropitant, it can be recommended for managing uremic vomiting in dogs. In addition, it has also exhibited an anesthetic sparing effect since the dogs treated with maropitant require a slightly lower percentage of isoflurane as an inhalational anesthetic. The NK-1 receptors are also identified in different areas of the pain pathways. Therefore, NK-1 receptor antagonists might be effective for managing visceral pain. However, further studies are required to establish the broad therapeutic potential of NK-1 receptor antagonist drugs, such as maropitant in canine medicine. It has been shown that the pain associated with the subcutaneous administration of maropitant is due to metacresol, a preservative used in some formulations. Therefore, the side effects can be eliminated by developing novel maropitant formulations specifically for dogs.
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Affiliation(s)
- K Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - K Jambagi
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - M Arya
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Aakanksha
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - S. N Chaithra
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - P. K Patel
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - S. K Dixit
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - K Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
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Shah T, Kanthabalan A, Pavlou M, Adeleke S, Giganti F, Brew-Graves C, Williams N, Haroon A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley R, Virdi J, Arya M, Mitra A, Payne H, Bomanji J, Winkler M, Horan G, Moore C, Emberton M, Punwani S, Ahmed H. MRI and targeted biopsies compared to transperineal mapping biopsies for targeted ablation in recurrent prostate cancer after radiotherapy: Primary outcomes of the FORECAST trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Reddy D, Peters M, Shah T, Van Son M, Huber P, Lomas D, Rakauskas A, Miah S, Guillaumier S, Dudderidge T, Hindley R, Emara A, Nigam R, Valerio M, Afzal N, Lewi H, Orczyk C, Ogden C, Persad R, Virdi J, Moore C, Arya M, Winkler M, Emberton M, Ahmed H. Cancer control outcomes following focal therapy using HIFU in 1,829 men with non-metastatic prostate cancer treated over 15 years. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rakauskas A, Shah TT, Peters M, Randeva JS, Hosking-Jervis F, Schmainda MJ, Orczyck C, Emberton M, Arya M, Moore C, Ahmed HU. Can quantitative analysis of multi-parametric MRI independently predict failure of focal salvage HIFU therapy in men with radio-recurrent prostate cancer? Urol Oncol 2021; 39:830.e1-830.e8. [PMID: 34049783 PMCID: PMC8639607 DOI: 10.1016/j.urolonc.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 12/01/2022]
Abstract
Quantitative mpMRI parameters predict failure of salvage HIFU in radiorecurrent prostate cancer Tumour microenvironment might produce heat-sinks which counter the effect of HIFU Ve value measured in the DCE sequence of the mpMRI is an independent predictor of treatment failure
Objectives Focal salvage HIFU is a feasible therapeutic option in some men who have recurrence after primary radiotherapy for prostate cancer. We aimed to determine if multi-parametric quantitative parameters, in addition to clinical factors, might have a role in independently predicting focal salvage HIFU outcomes. Methods A retrospective registry analysis included 150 consecutive men who underwent focal salvage HIFU (Sonablate500) (2006-2015); 89 had mpMRI available. Metastatic disease was excluded by nodal assessment on pelvic MRI, a radioisotope bone-scan and/or choline or FDG PET/CT scan. All men had mpMRI and either transperineal template prostate mapping biopsy or targeted and systematic TRUS-biopsy. mpMRI included T2‐weighted, diffusion‐weighted and dynamic contrast‐enhancement. Pre-HIFU quantitative mpMRI data was obtained using Horos DICOM Viewer v3.3.5 for general MRI parameters and IB DCE v2.0 plug-in. Progression-free survival (PFS) was defined by biochemical failure and/or positive localized or distant imaging results and/or positive biopsy and/or systemic therapy and/or metastases/prostate cancer‐specific death. Potential predictors of PFS were analyzed by univariable and multivariable Cox-regression. Results Median age at focal salvage HIFU was 71 years (interquartile range [IQR] 65–74.5) and median PSA pre-focal salvage treatment was 5.8ng/ml (3.8-8). Median follow-up was 35 months (23-47) and median time to failure was 15 months (7.8–24.3). D-Amico low, intermediate and high-risk disease was present in 1% (1/89), 40% (36/89) and 43% (38/89) prior to focal salvage HIFU (16% missing data). 56% (50/89) failed by the composite outcome. A total of 22 factors were evaluated on univariable and 8 factors on multivariable analysis. The following quantitative parameters were included: Ktrans, Kep, Ve, Vp, IS, rTTP and TTP. On univariable analysis, PSA, prostate volume at time of radiotherapy failure and Ve (median) value were predictors for failure. Ve represents extracellular fraction of the whole tissue volume. On multivariable analysis, only Ve (median) value remained as an independent predictor. Conclusions One pharmacokinetic quantitative parameter based on DCE sequences seems to independently predict failure following focal salvage HIFU for radio-recurrent prostate cancer. This likely relates to the tumor microenvironment producing heat-sinks which counter the heating effect of HIFU. Further validation in larger datasets and evaluating mechanisms to reduce heat-sinks are required.
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Affiliation(s)
- Arnas Rakauskas
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Jagpal S Randeva
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
| | - Feargus Hosking-Jervis
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
| | | | - Clement Orczyck
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manit Arya
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline Moore
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
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15
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Shah TT, Kanthabalan A, Pavlou M, Adeleke S, Giganti F, Brew-Graves C, Haroon A, Sidhu H, Freeman A, Nikapota A, Dudderidge T, Hindley RG, Arya M, Payne HA, Mitra A, Horan G, Moore C, Emberton M, Punwani S, Ahmed HU. MRI and targeted biopsies compared to transperineal mapping biopsies for targeted ablation in recurrent prostate cancer after radiotherapy: Primary outcomes of the FORECAST trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5009 Background: Radiotherapy is a common and effective treatment for localised prostate cancer. However, recurrence of cancer can occur in 10-15% of men in the following 5 years. Most patients with recurrence are managed using hormonal therapy with associated systemic side-effects and subsequent development of castrate resistance. Salvage prostatectomy confers a high risk of urine incontinence and rectal injury. Accurately localising and ablating only areas of recurrence within the prostate might be effective with fewer side-effects. The FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial assessed this diagnostic and treatment pathway for men with radiorecurrent cancer (NCT01883128). Methods: We first compared the accuracy of multi-parametric MRI (mp-MRI) and MRI-targeted biopsy in identifying areas of recurrent cancer to a transperineal template prostate mapping (TTPM) biopsy (Apr/2014-Jan/2018) in 181 patients from 6 UK centres. We then assessed the functional and cancer control outcomes of focally ablating areas of intraprostatic recurrence in 93 patients with localised or metastatic cancer (using cryotherapy or HIFU). Primary outcomes were sensitivity of mpMRI and MRI-targeted biopsies and urinary continence after focal ablation. A key secondary outcome was progression free survival (PFS) defined as no new metastases or hormone use (localised group only), or chemotherapy or further local treatment. Results: Of 181 men with suspicion of recurrence following radiotherapy, re-staging whole-body imaging (Choline PET and Bone Scan) showed localised disease in 128 (71%), nodal disease only in 13 (7%) and 38 (21%) metastatic. The sensitivity of MRI-targeted biopsy was 92% (95%CI 83-97%). Specificity, and positive and negative predictive values, were 75% (95%CI 45-92%), 94% (95%CI 86-98%) and 65% (95%CI 38-86%). 4/72 (6%) cancers were missed on TTPM biopsies alone and 6/72 (8%) were missed on MRI-targeted biopsies alone. Overall sensitivity of mpMRI was 81% (95%CI 73-88%) using Likert score 4-5 to denote a positive test. Specificity, and positive and negative predictive values, were 88% (95%CI 73-98%), 96% (95%CI 90-99%) and 57% (95%CI 42-70%). In the 93 men undergoing focal ablation, urinary continence was preserved in 78/93 (84%); 5/93 (5%) had a CTCAE grade 3+ adverse events. There were no rectal injuries. With a median follow-up of 27.8 [SD 1.3] months, PFS was 66% [54-75] at 24-months. Metastases-free survival in the 73 men with localised disease was 80% [95%CI 68–88] at 24-months. There were no cancer specific deaths. Conclusions: Prostate mpMRI and MRI-targeted biopsies can accurately detect and localise recurrent prostate cancer following radiotherapy. Focal ablation to areas of intra-prostatic recurrence preserves continence in the majority of men with good cancer control. Clinical trial information: NCT01883128.
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Affiliation(s)
| | | | | | - Sola Adeleke
- University College London, London, United Kingdom
| | - Francesco Giganti
- Division of Surgery and Interventional Science, University College London, London, UK, London, United Kingdom
| | - Chris Brew-Graves
- Division of Medicine, University College London, London, United Kingdom
| | - Athar Haroon
- Barts Health NHS Trust, St Bartholomew's Hospital, London, United Kingdom
| | - Harbir Sidhu
- University College London, London, United Kingdom
| | - Alex Freeman
- University College London Hospital, London, United Kingdom
| | | | - Tim Dudderidge
- University Hospital Southampton, Southampton, United Kingdom
| | - Richard G Hindley
- Basingstoke Hospital, Hampshire Hospitals Hospital NHS Foundation Trust, Basingstoke, United Kingdom
| | - Manit Arya
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Heather Ann Payne
- Department of Oncology, University College London and University College London Hospital, London, United Kingdom
| | - Anita Mitra
- Department of Oncology, University College London and University College London Hospital, London, United Kingdom
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, Kings Lynn, United Kingdom
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16
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van Son MJ, Peters M, Reddy D, Shah TT, Hosking-Jervis F, Robinson S, Lagendijk JJW, Mangar S, Dudderidge T, McCracken S, Hindley RG, Emara A, Nigam R, Persad R, Virdi J, Lewi H, Moore C, Orczyk C, Emberton M, Arya M, Ahmed HU, van der Voort van Zyp JRN, Winkler M, Falconer A. Conventional radical versus focal treatment for localised prostate cancer: a propensity score weighted comparison of 6-year tumour control. Prostate Cancer Prostatic Dis 2021; 24:1120-1128. [PMID: 33934114 DOI: 10.1038/s41391-021-00369-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/14/2021] [Accepted: 04/15/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND For localised prostate cancer, focal therapy offers an organ-sparing alternative to radical treatments (radiotherapy or prostatectomy). Currently, there is no randomised comparative effectiveness data evaluating cancer control of both strategies. METHODS Following the eligibility criteria PSA < 20 ng/mL, Gleason score ≤ 7 and T-stage ≤ T2c, we included 830 radical (440 radiotherapy, 390 prostatectomy) and 530 focal therapy (cryotherapy, high-intensity focused ultrasound or high-dose-rate brachytherapy) patients treated between 2005 and 2018 from multicentre registries in the Netherlands and the UK. A propensity score weighted (PSW) analysis was performed to compare failure-free survival (FFS), with failure defined as salvage treatment, metastatic disease, systemic treatment (androgen deprivation therapy or chemotherapy), or progression to watchful waiting. The secondary outcome was overall survival (OS). Median (IQR) follow-up in each cohort was 55 (28-83) and 62 (42-83) months, respectively. RESULTS At baseline, radical patients had higher PSA (10.3 versus 7.9) and higher-grade disease (31% ISUP 3 versus 11%) compared to focal patients. After PSW, all covariates were balanced (SMD < 0.1). 6-year weighted FFS was higher after radical therapy (80.3%, 95% CI 73.9-87.3) than after focal therapy (72.8%, 95% CI 66.8-79.8) although not statistically significant (p = 0.1). 6-year weighted OS was significantly lower after radical therapy (93.4%, 95% CI 90.1-95.2 versus 97.5%, 95% CI 94-99.9; p = 0.02). When compared in a three-way analysis, focal and LRP patients had a higher risk of treatment failure than EBRT patients (p < 0.001), but EBRT patients had a higher risk of mortality than focal patients (p = 0.008). CONCLUSIONS Within the limitations of a cohort-based analysis in which residual confounders are likely to exist, we found no clinically relevant difference in cancer control conferred by focal therapy compared to radical therapy at 6 years.
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Affiliation(s)
- Marieke J van Son
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. .,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. .,Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Max Peters
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Deepika Reddy
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Sunderland Royal Hospital, City Hospital Foundation Trust, Sunderland, UK
| | - Feargus Hosking-Jervis
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Stephen Robinson
- Division of Clinical Oncology, Department of Radiotherapy, Charing Cross Hospital, Imperial College London Healthcare NHS Trust, London, UK
| | - Jan J W Lagendijk
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Stephen Mangar
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, City Hospital Foundation Trust, Sunderland, UK
| | - Richard G Hindley
- Department of Urology, Hampshire Hospitals & Ain Shams University Hospitals, Basingstoke, UK
| | - Amr Emara
- Department of Urology, Hampshire Hospitals & Ain Shams University Hospitals, Basingstoke, UK
| | - Raj Nigam
- BMI Mount Alvernia Hospital, Guildford, Surrey, UK
| | - Raj Persad
- Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jaspal Virdi
- Department of Urology, Princes Alexandra Hospital NHS Trust, Harlow, UK.,Rivers Hospital, Essex, UK
| | | | - Caroline Moore
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Mark Emberton
- Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Manit Arya
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK.,Department of Urology, Princes Alexandra Hospital NHS Trust, Harlow, UK.,Rivers Hospital, Essex, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Matt Winkler
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Falconer
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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17
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Cathcart P, Ribeiro L, Moore C, Ahmed HU, Leslie T, Arya M, Orczyk C, Hindley RG, Cahill F, Prendergast A, Coetzee C, Yogeswaran Y, Tunna K, Sooriakumaran P, Emberton M. Outcomes of the RAFT trial: robotic surgery after focal therapy. BJU Int 2021; 128:504-510. [PMID: 33891378 DOI: 10.1111/bju.15432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To report toxicity of treatment observed in men participating in the Robotic surgery After Focal Therapy (RAFT) clinical trial. PATIENTS AND METHODS Men were eligible for this prospective single group interventional study if they had histologically confirmed recurrent/residual prostate adenocarcinoma following primary FT. The short-form Expanded Prostate Cancer Index Composite (EPIC-26) measured prior to salvage robotic prostatectomy (S-RARP) and 3-monthly post-operatively together with Clavien-Dindo complications (I-IV). Secondary outcomes included biochemical recurrence-free survival (BCFS) following surgery and need for salvage treatment after surgery. This study is registered with ClinicalTrials.gov NCT03011606. RESULTS Twenty-four men were recruited between February 2016 and September 2018. 1 patient withdrew from the trial after consenting and before S-RARP. 23 men completed 12-month post S-RARP follow-up. Median EPIC-26 urinary continence scores initially deteriorated after 3 months (82.4 vs 100) but there was no statistically significant difference from baseline at 12 months (100 vs 100, P = 0.31). Median lower urinary tract symptom scores improved after 12 months compared to baseline (93.8 vs 87.5, P = 0.01). At 12 months, 19/23 (83%) were pad-free and 22/23 (96%) required 0/1 pads. Median sexual function subscale scores deteriorated and remained low at 12 months (22.2 vs 58.3, P < 0.001). Utilising a minimally important difference of nine points, at 12 months after surgery 17/23 (74%) reported urinary continence to be 'better' or 'not different' to pre-operative baseline. The corresponding figure for sexual function (utilising a minimally important difference of 12 points) was 7/23 (30%). There was no statistically significant difference on median bowel/hormonal subscale scores. Only a single patient had a post-operative complication (Clavien-Dindo Grade I). BCFS at 12 months after surgery was 82.6% (95% confidence interval [CI]: 60.1-93.1%) while 4/23 (17%) received salvage radiation. CONCLUSIONS The RAFT clinical trial suggests toxicity of surgery after FT is low, with good urinary function outcomes, albeit sexual function deteriorated overall. Oncological outcomes at 12 months appear acceptable.
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Affiliation(s)
- Paul Cathcart
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Luis Ribeiro
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Caroline Moore
- Department of Urology, University College Hospital London, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals, Oxford, UK
| | - Manit Arya
- Department of Urology, University College Hospital London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Clement Orczyk
- Department of Urology, University College Hospital London, London, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Fidelma Cahill
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Aaron Prendergast
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Carike Coetzee
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Yathushan Yogeswaran
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kirsty Tunna
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Mark Emberton
- Department of Urology, University College Hospital London, London, UK
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18
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Kanthabalan A, Arya M, Freeman A, Mitra AV, Payne H, Peters M, Shah TT, Emberton M, Ahmed HU. Intraprostatic Cancer Recurrence following Radical Radiotherapy on Transperineal Template Mapping Biopsy: Implications for Focal Ablative Salvage Therapy. J Urol 2020; 204:950-955. [PMID: 32602770 DOI: 10.1097/ju.0000000000001201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Men in whom external beam radiotherapy fails are usually placed on delayed hormone therapy. Some of these men have localized recurrence that might be suitable for further local therapy. We describe patterns of recurrence and suitability for focal ablative therapy in those undergoing transperineal template prostate mapping biopsies. MATERIALS AND METHODS The study included 145 consecutive patients (December 2007 to May 2014) referred with suspicion of recurrence due to rising prostate specific antigen after external beam radiotherapy or brachytherapy who underwent transperineal template prostate mapping biopsies. Suitability for focal ablative therapy required the cancer to be unifocal or unilateral, or bilateral/multifocal with 1 dominant index lesion and secondary lesions with Gleason score 3+3=6 with no more than 3 mm cancer core involvement. RESULTS Mean patient age was 70.7 (SD 5.8) years. Median prostate specific antigen at time of transperineal template prostate mapping biopsy was 4.5 ng/ml (IQR 2.5-7.7). Overall 75.9% (110) were suitable for a form of focal salvage treatment, 40.7% (59) were suitable for quadrant ablation, 14.5% (21) hemiablation, 14.5% (21) bilateral focal ablation and 6.2% (9) for index lesion ablation. CONCLUSIONS Three-quarters of patients who have localized radiorecurrent prostate cancer may be suitable for focal ablative therapy to the prostate based on transperineal template prostate mapping biopsies.
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Affiliation(s)
- A Kanthabalan
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - A Freeman
- Department of Histopathology, UCLH NHS Foundation Trust, London, United Kingdom
| | - A V Mitra
- Department of Clinical Oncology, UCLH NHS Foundation Trust, London, United Kingdom
| | - H Payne
- Department of Clinical Oncology, UCLH NHS Foundation Trust, London, United Kingdom
| | - M Peters
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - T T Shah
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M Emberton
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - H U Ahmed
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
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19
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Huber PM, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, Guillaumier S, Hindley RG, Hosking-Jervis F, Leemann L, Lewi H, McCartan N, Moore CM, Nigam R, Odgen C, Persad R, Virdi J, Winkler M, Ahmed HU. Focal HIFU therapy for anterior compared to posterior prostate cancer lesions. World J Urol 2020; 39:1115-1119. [PMID: 32638084 PMCID: PMC8124043 DOI: 10.1007/s00345-020-03297-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/03/2020] [Indexed: 11/07/2022] Open
Abstract
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.
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Affiliation(s)
- Philipp M Huber
- Department of Urology, University Hospital Inselspital Berne, Bern, Switzerland.,Urologie St. Anna, Lucerne, Switzerland.,Department of Urology, UCLH NHS Foundation Trust, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Naveed Afzal
- Department of Urology, Dorset County Hospital NHS Trust, Dorchester, Dorset, UK
| | - Manit Arya
- Department of Urology, UCLH NHS Foundation Trust, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Silvan Boxler
- Department of Urology, University Hospital Inselspital Berne, Bern, Switzerland
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Stephanie Guillaumier
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Feargus Hosking-Jervis
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Fulham Palace Road, London, W6 8RF, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Lucas Leemann
- Department of Political Science, University of Zurich, Zurich, Switzerland
| | - Henry Lewi
- Springfield Hospital, Chelmsford, Essex, UK
| | - Neil McCartan
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Raj Nigam
- Department of Urology, Royal County Surrey Hospital NHS Trust, Guildford, Surrey, UK
| | - Chris Odgen
- Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Raj Persad
- Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Mathias Winkler
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Fulham Palace Road, London, W6 8RF, UK. .,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
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20
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Cathcart P, Moore C, Ahmed H, Leslie T, Arya M, Hindley R, Cahill F, Prendergast A, Coetzee C, Yogeswaran Y, Sooriakumaran P, Emberton M. Functional outcomes from the Robotic surgery After Focal Therapy (RAFT) clinical trial. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Kadner G, Valerio M, Giannakis I, Arya M, Lumen N, Ho B, Alonso S, Schulman C, Barber N, Amparore D, Porpigila F. Second generation of temporary implantable nitinol device (iTind) in men with lower urinary tract symptoms (LUTS): Who profit most from treatment? 2 year results of the MT-02-study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32815-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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22
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Miah S, Hosking-Jervis F, Connor MJ, Eldred-Evans D, Shah TT, Arya M, Barber N, Bhardwa J, Bott S, Burke D, Doherty A, Foster C, Freeman A, Hindley R, Jameson C, Karim O, Laniado M, Montgomery B, Nigam R, Punwani S, Sinclair A, Winkler M, Allen C, Ahmed HU. A Multicentre Analysis of the Detection of Clinically Significant Prostate Cancer Following Transperineal Image-fusion Targeted and Nontargeted Systematic Prostate Biopsy in Men at Risk. Eur Urol Oncol 2020; 3:262-269. [PMID: 31411968 DOI: 10.1016/j.euo.2019.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prostate biopsy guided by magnetic resonance imaging (MRI) is increasingly used to obtain tissue from men with suspected prostate cancer (PC). OBJECTIVE To report a multicentre series of image-fusion transperineal prostate biopsies and compare the diagnostic yield of clinically significant PC (csPC) between targeted and nontargeted biopsies. DESIGN, SETTING, AND PARTICIPANTS The study included 640 consecutive patients with elevated prostate specific antigen (PSA) presenting for first biopsy or following a previous negative transrectal biopsy under the care of 13 urologists in 11 centres in the UK (April 2014-June 2017). INTERVENTION Multiparametric MRI was carried out in 61 approved prostate MRI centres with transperineal targeted alone (n=283) or targeted plus nontargeted (n=357) transperineal rigid image-fusion targeted biopsy (MIM-Symphony-DX). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Rates of csPC and insignificant cancer detection in targeted and nontargeted biopsies were measured using a number of thresholds to define clinical significance. The primary definition was Gleason≥4+3 or any grade ≥6mm. RESULTS AND LIMITATIONS The mean age, median PSA, and median prostate volume for the cohort were 63.8yr (standard deviation [SD] 8.4), 6.3 ng/ml (SD 5.8), and 42.0cm3 (SD 24.7), respectively. Overall, 276/640 men (43.1%) were diagnosed with csPC. csPC was detected from targeted biopsies alone in 263/640 cases (41.1%). Of the 357 men who underwent nontargeted biopsies, three (0.8%) had csPC exclusively in nontargeted cores, with no evidence of cancer in targeted cores. Overall, 32/357 (9.0%) had csPC in nontargeted biopsies regardless of the targeted biopsy findings. Clinically insignificant disease in nontargeted biopsies was detected in 93/357 men (26.1%). Our findings were consistent across all other thresholds of clinical significance. Limitations include the lack of nontargeted biopsies in all men. CONCLUSIONS In this large multicentre series, nontargeted prostate biopsy cores had a low yield of csPC and a high yield of clinically insignificant PC. An image-fusion targeted-biopsy-only approach maintains high detection for csPC and low detection of clinically insignificant cancers. PATIENT SUMMARY In this report, we found that following prostate multiparametric magnetic resonance imaging and targeted transperineal biopsies of suspicious areas, the clinical value of performing additional extensive unguided biopsies of nonsuspicious areas is limited and can often find insignificant cancers that do not need treatment.
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Affiliation(s)
- Saiful Miah
- Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
| | - Feargus Hosking-Jervis
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Martin J Connor
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - David Eldred-Evans
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Taimur T Shah
- Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Manit Arya
- Department of Urology, University College London Hospital, London, UK
| | - Neil Barber
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | | | - Simon Bott
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - Daniel Burke
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - Alan Doherty
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | | | - Alex Freeman
- Department of Pathology, University College London Hospital, London, UK
| | | | | | - Omer Karim
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - Marc Laniado
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | | | - Raj Nigam
- Department of Urology, University College London Hospital, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital, London, UK
| | | | - Mathias Winkler
- Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital, London, UK
| | - Hashim U Ahmed
- Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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23
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Reddy D, Shah TT, Dudderidge T, McCracken S, Arya M, Dobbs C, Emberton M, Fiorentino F, Day E, Prevost AT, Staffurth J, Sydes M, Winkler M, Ahmed HU. Comparative Healthcare Research Outcomes of Novel Surgery in prostate cancer (IP4-CHRONOS): A prospective, multi-centre therapeutic phase II parallel Randomised Control Trial. Contemp Clin Trials 2020; 93:105999. [PMID: 32302790 DOI: 10.1016/j.cct.2020.105999] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Focal therapy (FT) targets individual areas of cancer within the prostate, providing oncological control with minimal side-effects. Early evidence demonstrates encouraging short-medium-term outcomes. With no randomized controlled trials (RCT) comparing FT to radical therapies, Comparative Healthcare Research Outcomes of Novel Surgery in prostate cancer (CHRONOS) will compare the cancer control of these two strategies. PATIENTS AND METHODS CHRONOS is a parallel phase II RCT for patients with clinically significant non-metastatic prostate cancer, dependent upon clinician/patient decision, patients will enrol into either CHRONOS-A or CHRONOS-B. CHRONOS-A will randomize patients to either radical treatment or FT. CHRONOS-B is a multi-arm, multistage RCT comparing focal therapy alone to FT with neoadjuvant agents that might improve the current focal therapy outcomes. An internal pilot will determine the feasibility of, and compliance to, randomization. The proposed definitive study plans to recruit and randomize 1190 patients into CHRONOS-A and 1260 patients into CHRONOS-B. RESULTS Primary outcome in CHRONOS-A is progression-free survival (transition to salvage local or systemic therapy, development of metastases or prostate-cancer-related mortality) and in CHRONOS-B is failure-free survival (includes the above definition and recurrence of clinically significant prostate cancer after initial FT). Secondary outcomes include adverse events, health economics and functional outcomes measured using validated questionnaires. CHRONOS is powered to assess non-inferiority of FT compared to radical therapy in CHRONOS-A, and superiority of neoadjuvant agents with FT in CHRONOS-B. CONCLUSION CHRONOS will assess the oncological outcomes after FT compared to radical therapy and whether neoadjuvant treatments improve cancer control following one FT session.
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Affiliation(s)
- Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK; Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Interventional Sciences, University College London, University College Hospital, London, UK
| | | | - Mark Emberton
- Department of Surgery and Interventional Sciences, University College London, University College Hospital, London, UK
| | | | - Emily Day
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | | | - Matthew Sydes
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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24
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Reddy D, Shah TT, van Son M, Guillaumier S, Hosking-Jervis F, Dudderidge T, McCracken S, Nigam R, Hindley R, McCartan N, Afzal N, Lewi H, Persad R, Virdi J, Orczyk C, Moore C, Arya M, Emberton M, Winkler M, Ahmed HU. Oncological outcomes of 356 patients undergoing salvage focal ablative HIFU or cryotherapy following radiation failure. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5582 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. Methods: 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. 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. Prostate-specific mortality was 2.8%. Overall 3 (0.8%) patients were managed for fistula formation, 16 (4.5%) were treated for UTIs. Conclusions: 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.
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Affiliation(s)
| | | | | | | | | | - Tim Dudderidge
- University Hospital Southampton, Southampton, United Kingdom
| | | | - Raj Nigam
- University College London Hospitals, London, United Kingdom
| | | | - Neil McCartan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Naveed Afzal
- Dorset County Hampshire NHS Trust, Dorchester, United Kingdom
| | - Henry Lewi
- Springfield Hospital, Chelmsford, United Kingdom
| | - Raj Persad
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Jaspal Virdi
- The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom
| | | | | | - Manit Arya
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Mathias Winkler
- Imperial College Healthcare NHS Trust, London, United Kingdom
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25
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Ricardo CP, Evie I, Henry M, Sanchez-Nieto J, Jayawardena M, Soula A, Daldoul K, Arya M, O'Grady C, Dewhirst O, Smart M, Munye M, Hasan J. Development of process analytical technology to monitor the cell secretome during differentiation of pluripotent stem cells. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Huber PM, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, Guillaumier S, Hindley RG, Hosking-Jervis F, Leemann L, Lewi H, McCartan N, Moore CM, Nigam R, Odgen C, Persad R, Thalmann GN, Virdi J, Winkler M, Ahmed HU. An Exploratory Study of Dose Escalation vs Standard Focal High-Intensity Focused Ultrasound for Treating Nonmetastatic Prostate Cancer. J Endourol 2020; 34:641-646. [PMID: 32253928 DOI: 10.1089/end.2019.0613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Analysis of treatment success regarding oncological recurrence rate between standard and dose escalation focal high-intensity focused ultrasound (HIFU) of prostate cancer. Materials and Methods: In this analysis of our prospectively maintained HIFU (Sonablate® 500) database, 598 patients were identified who underwent a focal HIFU (Sonablate 500) between March 2007 and November 2016. Follow-up occurred with 3-monthly clinic visits and prostate specific antigen (PSA) testing in the first year. Thereafter, PSA was measured 6-monthly or annually at least. Routine and for-cause multiparametric MRI (mpMRI) was conducted with biopsy for MRI suspicion of recurrence. Treatments were delivered in a quadrant or hemiablation fashion depending on the gland volume as well as tumor volume and location. Before mid-2015, standard focal HIFU was used (two HIFU blocks); after this date, some urologists conducted dose escalation focal HIFU (three 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, tumor 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 (interquartile range [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 37 mL (IQR 17-103) in the standard group and 47.5 mL (IQR 19-121) in the dose-escalation group. As tumor volume on mpMRI and Gleason score were major matching criteria, these were identical with 0.43 mL (IQR 0.05-2.5) and Gleason 3 + 3 = 6 in 1 out of 32 (3%), 3 + 4 = 7 in 27 out of 32 (84%), and 4 + 3 = 7 in 4 out of 32 (13%). Recurrence in treated areas was found in 10 out of 32 (31%) when standard treatment zones were applied, and in 6 out of 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 with standard focal HIFU. Further prospective comparative studies are needed.
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Affiliation(s)
- Philipp M Huber
- Department of Urology, University Hospital Inselspital Berne, Berne, Switzerland
- Urology, St. Anna Klinik Lucerne, Lucerne, Switzerland
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Naveed Afzal
- Department of Urology, Dorset County Hospital NHS Trust, Dorset, United Kingdom
| | - Manit Arya
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom
| | - Silvan Boxler
- Department of Urology, University Hospital Inselspital Berne, Berne, Switzerland
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Mark Emberton
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
| | - Stephanie Guillaumier
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, United Kingdom
| | - Feargus Hosking-Jervis
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lucas Leemann
- Department of Political Science, University of Zurich, Zurich, Switzerland
| | - Henry Lewi
- Springfield Hospital, Chelmsford, Essex, United Kingdom
| | - Neil McCartan
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
| | - Caroline M Moore
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
| | - Raj Nigam
- Department of Urology, Royal Surrey County Hospital NHS Trust, Surrey, United Kingdom
| | - Chris Odgen
- Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Raj Persad
- Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - George N Thalmann
- Department of Urology, University Hospital Inselspital Berne, Berne, Switzerland
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom
| | - Mathias Winkler
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Hashim U Ahmed
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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27
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Eldred-Evans D, Neves JB, Simmons LAM, Kanthabalan A, McCartan N, Shah TT, Arya M, Charman SC, Freeman A, Moore CM, Punwani S, Emberton M, Ahmed HU. Added value of diffusion-weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial. BJU Int 2020; 125:391-398. [PMID: 31733173 DOI: 10.1111/bju.14953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the additional diagnostic value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE) in men requiring a repeat biopsy within the PICTURE study. PATIENTS AND METHODS PICTURE was a paired-cohort confirmatory study in which 249 men who required further risk stratification after a previous non-magnetic resonance imaging (MRI)-guided transrectal ultrasonography-guided biopsy underwent a 3-Tesla (3T) multiparametic (mp)MRI consisting of T2-weighted imaging (T2W), DWI and DCE, followed by transperineal template prostate mapping biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE. Area under the receiver-operating characteristic curve (AUROC) analysis was performed to compare the diagnostic accuracy of each combination. The threshold for a positive mpMRI was set at a LIKERT score ≥3. Clinically significant prostate cancer was analysed across a range of definitions including UCL/Ahmed definition 1 (primary definition), UCL/Ahmed definition 2, any Gleason ≥3 + 4 and any Gleason ≥4 + 3. RESULTS Of 249 men, sequential MRI reporting was available for 246. There was a higher rate of equivocal lesions (44.6%) using T2W alone compared to the addition of DWI (23.9%) and DCE (19.8%). Using the primary definition of clinically significant disease, there was no significant difference in the overall accuracy between T2W, with an AUROC of 0.74 (95% confidence interval [CI] 0.68-0.80), T2W+DWI at 0.76 (95% CI 0.71-0.82), and T2W+DWI+DCE, with an AUROC of 0.77 (95% CI 0.71-0.82; P = 0.55). The AUROC values remained comparable using other definitions of clinically significant disease including UCL/Ahmed definition 2 (P = 0.79), Gleason ≥3 + 4 (P = 0.53) and Gleason ≥4 + 3 (P = 0.53). CONCLUSIONS Using 3T MRI, a high level of diagnostic accuracy can be achieved using T2W as a single parameter in men with a prior biopsy; however, such a strategy can lead to a higher rate of equivocal lesions.
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Affiliation(s)
- David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Joana B Neves
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Lucy A M Simmons
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Abi Kanthabalan
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Neil McCartan
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
| | - Manit Arya
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
| | - Susan C Charman
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Alex Freeman
- Department of Pathology, UCLH NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, UCLH NHS Foundation Trust, London, UK
- Centre for Medical Imaging, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery and Interventional Science, University College London, Faculty of Medical Sciences, London, UK
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28
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Lovegrove CE, Peters M, Guillaumier S, Arya M, Afzal N, Dudderidge T, Hosking-Jervis F, Hindley RG, Lewi H, McCartan N, Moore CM, Nigam R, Ogden C, Persad R, Virdi J, Winkler M, Emberton M, Ahmed HU, Shah TT, Minhas S. Evaluation of functional outcomes after a second focal high-intensity focused ultrasonography (HIFU) procedure in men with primary localized, non-metastatic prostate cancer: results from the HIFU Evaluation and Assessment of Treatment (HEAT) registry. BJU Int 2020; 125:853-860. [PMID: 31971335 DOI: 10.1111/bju.15004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess change in functional outcomes after a second focal high-intensity focused ultrasonography (HIFU) treatment compared with outcomes after one focal HIFU treatment. PATIENTS AND METHODS In this multicentre study (2005-2016), 821 men underwent focal HIFU for localized non-metastatic prostate cancer. The patient-reported outcome measures of International Prostate Symptom Score (IPSS), pad usage and erectile function (EF) score were prospectively collected for up to 3 years. To be included in the study, completion of at least one follow-up questionnaire was required. The primary outcome was comparison of change in functional outcomes between baseline and follow-up after one focal HIFU procedure vs after a second focal HIFU procedure, using IPSS, Expanded Prostate Cancer Index Composite (EPIC) and International Index of Erectile Function (IIEF) questionnaires. RESULTS Of 821 men, 654 underwent one focal HIFU procedure and 167 underwent a second focal HIFU procedure. A total of 355 (54.3%) men undergoing one focal HIFU procedure and 65 (38.9%) with a second focal HIFU procedure returned follow-up questionnaires, respectively. The mean age and prostate-specific antigen level were 66.4 and 65.6 years, and 7.9 and 8.4 ng/mL, respectively. After one focal HIFU treatment, the mean change in IPSS was -0.03 (P = 0.02) and in IIEF (EF score) it was -0.4 (P = 0.02) at 1-2 years, with no subsequent decline. Absolute rates of erectile dysfunction increased from 9.9% to 20.8% (P = 0.08), leak-free continence decreased from 77.9% to 72.8% (P = 0.06) and pad-free continence from 98.6% to 94.8% (P = 0.07) at 1-2 years, respectively. IPSS prior to second focal HIFU treatment compared to baseline IPSS prior to first focal HIFU treatment was lower by -1.3 (P = 0.02), but mean IPSS change was +1.4 at 1-2 years (P = 0.03) and +1.2 at 2-3 years (P = 0.003) after the second focal HIFU treatment. The mean change in EF score after the second focal HIFU treatment was -0.2 at 1-2 years (P = 0.60) and -0.5 at 2-3 years (P = 0.10), with 17.8% and 6.2% of men with new erectile dysfunction. The rate of new pad use was 1.8% at 1-2 years and 2.6% at 2-3 years. CONCLUSION A second focal HIFU procedure causes minor detrimental effects on urinary function and EF. These data can be used to counsel patients with non-metastatic prostate cancer prior to considering HIFU therapy.
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Affiliation(s)
- Catherine E Lovegrove
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Max Peters
- Department of Radiation Oncology, Cancer Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Stephanie Guillaumier
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Manit Arya
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK.,Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Naveed Afzal
- Department of Urology, Dorset County Hospital NHS Trust, Dorset, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Feargus Hosking-Jervis
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Radiation Oncology, Cancer Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Richard G Hindley
- Department of Urology, Hampshire Hospitals NHS Foundation Trust, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - Neil McCartan
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Raj Nigam
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK.,Department of Urology, Royal Surrey County Hospital NHS Trust, Surrey, UK
| | - Chris Ogden
- Department of Academic Urology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Raj Persad
- Department of Urology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Jaspal Virdi
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Mathias Winkler
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Taimur T Shah
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Suks Minhas
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Adeleke S, Latifoltojar A, Sidhu H, Galazi M, Shah TT, Clemente J, Davda R, Payne HA, Chouhan MD, Lioumi M, Chua S, Freeman A, Rodriguez-Justo M, Coolen A, Vadgama S, Morris S, Cook GJ, Bomanji J, Arya M, Chowdhury S, Wan S, Haroon A, Ng T, Ahmed HU, Punwani S. Localising occult prostate cancer metastasis with advanced imaging techniques (LOCATE trial): a prospective cohort, observational diagnostic accuracy trial investigating whole-body magnetic resonance imaging in radio-recurrent prostate cancer. BMC Med Imaging 2019; 19:90. [PMID: 31730466 PMCID: PMC6858718 DOI: 10.1186/s12880-019-0380-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/13/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Accurate whole-body staging following biochemical relapse in prostate cancer is vital in determining the optimum disease management. Current imaging guidelines recommend various imaging platforms such as computed tomography (CT), Technetium 99 m (99mTc) bone scan and 18F-choline and recently 68Ga-PSMA positron emission tomography (PET) for the evaluation of the extent of disease. Such approach requires multiple hospital attendances and can be time and resource intensive. Recently, whole-body magnetic resonance imaging (WB-MRI) has been used in a single visit scanning session for several malignancies, including prostate cancer, with promising results, providing similar accuracy compared to the combined conventional imaging techniques. The LOCATE trial aims to investigate the application of WB-MRI for re-staging of patients with biochemical relapse (BCR) following external beam radiotherapy and brachytherapy in patients with prostate cancer. METHODS/DESIGN The LOCATE trial is a prospective cohort, multi-centre, non-randomised, diagnostic accuracy study comparing WB-MRI and conventional imaging. Eligible patients will undergo WB-MRI in addition to conventional imaging investigations at the time of BCR and will be asked to attend a second WB-MRI exam, 12-months following the initial scan. WB-MRI results will be compared to an enhanced reference standard comprising all the initial, follow-up imaging and non-imaging investigations. The diagnostic performance (sensitivity and specificity analysis) of WB-MRI for re-staging of BCR will be investigated against the enhanced reference standard on a per-patient basis. An economic analysis of WB-MRI compared to conventional imaging pathways will be performed to inform the cost-effectiveness of the WB-MRI imaging pathway. Additionally, an exploratory sub-study will be performed on blood samples and exosome-derived human epidermal growth factor receptor (HER) dimer measurements will be taken to investigate its significance in this cohort. DISCUSSION The LOCATE trial will compare WB-MRI versus the conventional imaging pathway including its cost-effectiveness, therefore informing the most accurate and efficient imaging pathway. TRIAL REGISTRATION LOCATE trial was registered on ClinicalTrial.gov on 18th of October 2016 with registration reference number NCT02935816.
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Affiliation(s)
- Sola Adeleke
- Centre for Medical Imaging, University College London, 2nd floor Charles Bell house, 43-45 Foley Street, London, W1W 7TS UK
| | - Arash Latifoltojar
- Centre for Medical Imaging, University College London, 2nd floor Charles Bell house, 43-45 Foley Street, London, W1W 7TS UK
| | - Harbir Sidhu
- Centre for Medical Imaging, University College London, 2nd floor Charles Bell house, 43-45 Foley Street, London, W1W 7TS UK
- Department of Radiology, University College London Hospital, London, 235 Euston Road, London, NW1 2BU UK
| | - Myria Galazi
- Molecular Oncology Group, University College London, Cancer Institute, Paul O’Gorman Building, 72 Huntley Street, London, WC1E 6DD UK
| | - Taimur T. Shah
- Division of Surgery and Interventional Science, University College London, 4th floor, 21 University Street, London, WC1E UK
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joey Clemente
- Centre for Medical Imaging, University College London, 2nd floor Charles Bell house, 43-45 Foley Street, London, W1W 7TS UK
| | - Reena Davda
- Oncology Department, University College London Hospital, 235 Euston Road, London, NW1 2BU UK
| | - Heather Ann Payne
- Oncology Department, University College London Hospital, 235 Euston Road, London, NW1 2BU UK
| | - Manil D. Chouhan
- Centre for Medical Imaging, University College London, 2nd floor Charles Bell house, 43-45 Foley Street, London, W1W 7TS UK
- Department of Radiology, University College London Hospital, London, 235 Euston Road, London, NW1 2BU UK
| | - Maria Lioumi
- Comprehensive Cancer Imaging Centre (CCIC), King’s College, London, New Hunt’s House, Guy’s Campus, London, SE1 1UL UK
| | - Sue Chua
- Department of Nuclear Medicine, The Royal Marsden Hospital NHS Foundation Trust, Down’s Road, Sutton, SM2 5PT UK
| | - Alex Freeman
- Histopathology Department, University College London Hospital, 4th Floor, Rockefeller Building University Street, London, WC1 6DE UK
| | - Manuel Rodriguez-Justo
- Histopathology Department, University College London Hospital, 4th Floor, Rockefeller Building University Street, London, WC1 6DE UK
| | - Anthony Coolen
- Institute for Mathematical and Molecular Biomedicine, King’s College London, Hodgkin Building, Guy’s Campus, London, SE1 1UL UK
| | - Sachin Vadgama
- Department of Applied Health Research, University College London, 1-19 Torrington Place, Fitzrovia, London, WC1E 7HB UK
| | - Steve Morris
- Department of Applied Health Research, University College London, 1-19 Torrington Place, Fitzrovia, London, WC1E 7HB UK
| | - Gary J. Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, Lambeth Wing St. Thomas’ Hospital, London, SE1 7EH UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospital, 5th Floor Tower, 235 Euston Road, London, NW1 2BU UK
| | - Manit Arya
- Urology Department, University College Hospital, Westmoreland Street, 16-18 Westmoreland Street, London, W1G 8PH UK
| | - Simon Chowdhury
- Oncology Department, Guy’s and St. Thomas’ Hospital, Westminster Bridge road, Lambeth, London, SE1 7EH UK
| | - Simon Wan
- Institute of Nuclear Medicine, University College London Hospital, 5th Floor Tower, 235 Euston Road, London, NW1 2BU UK
| | - Athar Haroon
- Department of Nuclear Medicine, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE UK
| | - Tony Ng
- Molecular Oncology Group, University College London, Cancer Institute, Paul O’Gorman Building, 72 Huntley Street, London, WC1E 6DD UK
| | - Hashim Uddin Ahmed
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Urology Department, Imperial College Healthcare NHS Trust, London, W2 1NY UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 2nd floor Charles Bell house, 43-45 Foley Street, London, W1W 7TS UK
- Department of Radiology, University College London Hospital, London, 235 Euston Road, London, NW1 2BU UK
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30
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Khoo CC, Eldred-Evans D, Peters M, Bertoncelli Tanaka M, Noureldin M, Miah S, Shah T, Connor MJ, Reddy D, Clark M, Lakhani A, Rockall A, Hosking-Jervis F, Cullen E, Arya M, Hrouda D, Qazi H, Winkler M, Tam H, Ahmed HU. Likert vs PI-RADS v2: a comparison of two radiological scoring systems for detection of clinically significant prostate cancer. BJU Int 2019; 125:49-55. [PMID: 31599113 DOI: 10.1111/bju.14916] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the clinical validity and utility of Likert assessment and the Prostate Imaging Reporting and Data System (PI-RADS) v2 in the detection of clinically significant and insignificant prostate cancer. PATIENTS AND METHODS A total of 489 pre-biopsy multiparametric magnetic resonance imaging (mpMRI) scans in consecutive patients were subject to prospective paired reporting using both Likert and PI-RADS v2 by expert uro-radiologists. Patients were offered biopsy for any Likert or PI-RADS score ≥4 or a score of 3 with PSA density ≥0.12 ng/mL/mL. Utility was evaluated in terms of proportion biopsied, and proportion of clinically significant and insignificant cancer detected (both overall and on a 'per score' basis). In those patients biopsied, the overall accuracy of each system was assessed by calculating total and partial area under the receiver-operating characteristic (ROC) curves. The primary threshold of significance was Gleason ≥3 + 4. Secondary thresholds of Gleason ≥4 + 3, Ahmed/UCL1 (Gleason ≥4 + 3 or maximum cancer core length [CCL] ≥6 or total CCL≥6) and Ahmed/UCL2 (Gleason ≥3 + 4 or maximum CCL ≥4 or total CCL ≥6) were also used. RESULTS The median (interquartile range [IQR]) age was 66 (60-72) years and the median (IQR) prostate-specific antigen level was 7 (5-10) ng/mL. A similar proportion of men met the biopsy threshold and underwent biopsy in both groups (83.8% [Likert] vs 84.8% [PI-RADS v2]; P = 0.704). The Likert system predicted more clinically significant cancers than PI-RADS across all disease thresholds. Rates of insignificant cancers were comparable in each group. ROC analysis of biopsied patients showed that, although both scoring systems performed well as predictors of significant cancer, Likert scoring was superior to PI-RADS v2, exhibiting higher total and partial areas under the ROC curve. CONCLUSIONS Both scoring systems demonstrated good diagnostic performance, with similar rates of decision to biopsy. Overall, Likert was superior by all definitions of clinically significant prostate cancer. It has the advantages of being flexible, intuitive and allowing inclusion of clinical data. However, its use should only be considered once radiologists have developed sufficient experience in reporting prostate mpMRI.
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Affiliation(s)
- Christopher C Khoo
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Max Peters
- Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands
| | - Mariana Bertoncelli Tanaka
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mohamed Noureldin
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Saiful Miah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Martin Clark
- Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Amish Lakhani
- Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Andrea Rockall
- Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Feargus Hosking-Jervis
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Emma Cullen
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Manit Arya
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - David Hrouda
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hasan Qazi
- Department of Urology, St. George's Hospital, St. George's Healthcare NHS Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Henry Tam
- Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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31
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Shah TT, Peters M, Miah S, Eldred-Evans D, Yap T, Hosking-Jervis F, Dudderidge T, Hindley RG, McCracken S, Greene D, Nigam R, Valerio M, Winkler M, Virdi J, Arya M, Ahmed HU, Minhas S. Assessment of Return to Baseline Urinary and Sexual Function Following Primary Focal Cryotherapy for Nonmetastatic Prostate Cancer. Eur Urol Focus 2019; 7:301-308. [PMID: 31590961 DOI: 10.1016/j.euf.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/11/2019] [Accepted: 09/04/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The oncological outcomes in men with clinically significant prostate cancer following focal cryotherapy are promising, although functional outcomes are under-reported. OBJECTIVE To determine the impact of focal cryotherapy on urinary and sexual function, specifically assessing return to baseline function. DESIGN, SETTING, AND PARTICIPANTS Between October 2013 and November 2016, 58 of 122 men who underwent focal cryotherapy for predominantly anterior clinically significant localised prostate cancer within a prospective registry returned patient-reported outcome measure questionnaires, which included International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-15) questionnaires. INTERVENTION Standard cryotherapy procedure using either the SeedNet or the Visual-ICE cryotherapy system. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome was return to baseline function of IPSS score and IIEF erectile function (EF) subdomain. Cumulative incidence and Cox-regression analyses were performed. RESULTS AND LIMITATIONS Probability of returning to baseline IPSS function was 78% at 12 mo and 87% at both 18 and 24 mo, with recovery seen up to 18 mo. For IIEF (EF domain), the probability of returning to baseline function was 85% at 12 mo and 89% at both 18 and 24 mo, with recovery seen up to 18 mo. Only the preoperative IIEF-EF score was associated with a poor outcome (hazard ratio 0.96, 95% confidence interval 0.93-0.999, p = 0.04). The main limitation was that only half of the patients returned their questionnaires. CONCLUSIONS In men undergoing primary focal cryotherapy, there is a high degree of preservation of urinary and erectile function with return to baseline function occurring from 3 mo and continuing up to 18 mo after focal cryotherapy. PATIENT SUMMARY In men who underwent focal cryotherapy for prostate cancer, approximately nine in 10 returned to their baseline urinary and sexual function. Keeping in mind that level 1 evidence and long-term data are still needed, in men who wish to preserve urinary and sexual function, focal cryotherapy may be considered an alternative treatment option to radical therapy.
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Affiliation(s)
- Taimur T Shah
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital (UCLH), UK.
| | - Max Peters
- Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands
| | - Saiful Miah
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK
| | - David Eldred-Evans
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tet Yap
- Department of Urology, Guy's Hospital, Great Maze Pond, London, UK
| | - Feargus Hosking-Jervis
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, University College London Hospital (UCLH), UK; Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Stuart McCracken
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Damian Greene
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK
| | - Raj Nigam
- Department of Urology, Royal Surrey County Hospital NHS Trust, UK
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mathias Winkler
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital (UCLH), UK; Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Stabile A, Orczyk C, Hosking-Jervis F, Giganti F, Arya M, Hindley RG, Dickinson L, Allen C, Punwani S, Jameson C, Freeman A, McCartan N, Montorsi F, Briganti A, Ahmed HU, Emberton M, Moore CM. Medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer. BJU Int 2019; 124:431-440. [PMID: 30753756 DOI: 10.1111/bju.14710] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To report medium-term oncological outcomes in men receiving primary focal treatment with high-intensity focused ultrasonography ( HIFU) for prostate cancer (PCa). PATIENTS AND METHODS Consecutive patients with PCa treated with primary focal HIFU at two centres by six treating clinicians were assessed. Patients were submitted to either focal ablation or hemi-ablation using HIFU (Sonablate 500). The primary objective of the study was to assess medium-term oncological outcomes, defined as overall survival, freedom from biopsy failure, freedom from any further treatment and freedom from radical treatment after focal HIFU. The secondary objective was to evaluate the changes in pathological features among patients treated with focal HIFU over time. We also assessed the relationship between year of surgery and 5-year retreatment probability. RESULTS A total of 1032 men treated between November 2005 and October 2017 were assessed. The median age was 65 years and median prostate-specific antigen level was 7 ng/mL. The majority of patients had a Gleason score of 3 + 4 or above (80.3%). The median (interquartile range) follow-up was 36 (14-64) months. The overall survival rates at 24, 60 and 96 months were 99%, 97% and 97%, respectively. Freedom from biopsy failure, defined as absence of Gleason 3 + 4 disease, was 84%, 64% and 54% at 24, 60 and 96 months. Freedom from any further treatment was 85%, 59% and 46% at 24, 60 and 96 months, respectively. Approximately 70% of patients who were retreated received a second focal treatment. Freedom from radical treatment was 98%, 91% and 81% at 24, 60 and 96 months. During the study period, we observed an increase in the proportion of patients undergoing focal HIFU with Gleason 3 + 4 disease and with T2 stage disease as defined by multiparametric magnetic resonance imaging. Finally, there was a reduction over time in the proportion of patients undergoing re-treatment within 5 years of first treatment. CONCLUSIONS Focal HIFU for PCa is a feasible therapeutic strategy, with acceptable survival and oncological results and a reduction in the 5-year retreatment rates over the last decade. Re-do focal treatment is a feasible technique whose functional and oncological outcomes have still to be evaluated.
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Affiliation(s)
- Armando Stabile
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Urology and Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Clement Orczyk
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Francesco Giganti
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manit Arya
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Richard G Hindley
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Charles Jameson
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil McCartan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Caroline M Moore
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
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33
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Shah TT, Peters M, Eldred-Evans D, Miah S, Yap T, Faure-Walker NA, Hosking-Jervis F, Thomas B, Dudderidge T, Hindley RG, McCracken S, Greene D, Nigam R, Valerio M, Minhas S, Winkler M, Arya M, Ahmed HU. Early-Medium-Term Outcomes of Primary Focal Cryotherapy to Treat Nonmetastatic Clinically Significant Prostate Cancer from a Prospective Multicentre Registry. Eur Urol 2019; 76:98-105. [DOI: 10.1016/j.eururo.2018.12.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/18/2018] [Indexed: 01/23/2023]
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34
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Khoo C, Eldred-Evans D, Jaenicke J, Bertoncelli Tanaka M, Shah T, Miah S, Connor M, Reddy D, Sethi J, Forde A, Bhola-Stewart H, Smith A, Carton J, Lloyd J, Mannion E, Hosking-Jervis F, Cullen E, Cartwright R, Clark M, Arya M, Hrouda D, Winkler M, Tam H, Ahmed H. Likert vs. PI-RADS v2: A comparison of two radiological scoring systems for detection of clinically significant prostate cancer. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31350-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Davda R, Orczyk C, Prentice M, Sarova A, Arya M, Ahmed H, Emberton M, Moore C, Mitra A, Payne HA. Late toxicity described using patient reported outcomes measures (PROMS) in men treated with salvage radiation following primary high intensity focal ultrasound (HIFU) for localized prostate cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
131 Background: In primary treatment of localised prostate cancer, minimally invasive ablative therapies such as HIFU aim to achieve cancer control whilst offering a potentially favourable toxicity profile. At 5 years median follow up, 12% of patients treated with focal HIFU require salvage therapy. PROMS using Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC‐CP) provide a validated and clinically relevant tool to assess and quantify side effects from pelvic radiotherapy. There is limited data on late toxicity using PROMs with salvage radiotherapy in this setting. Methods: Retrospective analysis from prospectively collected data of 28 patients who received salvage radiotherapy at our institution 2010-2018 was performed. Late bowel and urinary toxicity measured by EPIC-CP is reported. Results: Gleason score at diagnosis: 3+3 4/28; 3+4 22/28; 4+3 2/28. HIFU treatment received: focal: 9/28; whole gland: 6/28; focal and redo focal: 7/28; focal and redo whole gland: 1/28; whole gland and redo: 5/28. All patients had mpMRI and biopsy proven recurrence with median PSA 6.6 ng/ml (0.57- 30.89). Median age at radiation was 67 years (55-80). Patients received 74 Gy to the prostate and 4 patients received additional pelvic lymph node irradiation. Three men received conformal radiotherapy (multiphase technique) and 25 arcing intensity modulated radiotherapy with hormone therapy as per risk stratification. Cumulative incidence of toxicity is reported at median follow-up of 43 months (7-99). Overall urinary function: no problem 8/28; very small problem 4/28; small problem 7/28; moderate problem 5/28; big problem 4/28 Urinary Incontinence Symptom Score: 2.5/12 (0-12) Urinary Irritation /Obstructive Symptom Score: 3.1/12 (0-12) Bowel Symptom Score: 3.5/12 (0-11) Biochemical relapse has occurred in 2/28 patients. Conclusions: Functional and oncological outcomes for a greater number of patients treated with minimally invasive ablative therapies followed by salvage radiation are required, however this data suggests radiation is a well-tolerated and effective salvage option following primary HIFU.
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Affiliation(s)
- Reena Davda
- University College London Hospitals NHS Foundation Trust, London, AL, United Kingdom
| | | | - Mark Prentice
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Aylin Sarova
- University College London, London, United Kingdom
| | - Manit Arya
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Anita Mitra
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Heather Ann Payne
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Olivier J, Stavrinides V, Kay J, Freeman A, Pye H, Ahmed Z, Carmona Echeverria L, Heavey S, Simmons LAM, Kanthabalan A, Arya M, Briggs T, Barratt D, Charman SC, Gelister J, Hawkes D, Hu Y, Jameson C, McCartan N, Punwani S, van der Muelen J, Moore C, Emberton M, Ahmed HU, Whitaker HC. Immunohistochemical biomarker validation in highly selective needle biopsy microarrays derived from mpMRI-characterized prostates. Prostate 2018; 78:1229-1237. [PMID: 30073682 DOI: 10.1002/pros.23698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/05/2018] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Diagnosing prostate cancer routinely involves tissue biopsy and increasingly image guided biopsy using multiparametric MRI (mpMRI). Excess tissue after diagnosis can be used for research to improve the diagnostic pathway and the vertical assembly of prostate needle biopsy cores into tissue microarrays (TMAs) allows the parallel immunohistochemical (IHC) validation of cancer biomarkers in routine diagnostic specimens. However, tissue within a biopsy core is often heterogeneous and cancer is not uniformly present, resulting in needle biopsy TMAs that suffer from highly variable cancer detection rates that complicate parallel biomarker validation. MATERIALS AND METHODS The prostate cores with the highest tumor burden (in terms of Gleason score and/or maximum cancer core length) were obtained from 249 patients in the PICTURE trial who underwent transperineal template prostate mapping (TPM) biopsy at 5 mm intervals preceded by mpMRI. From each core, 2 mm segments containing tumor or benign tissue (as assessed on H&E pathology) were selected, excised and embedded vertically into a new TMA block. TMA sections were then IHC-stained for the routinely used prostate cancer biomarkers PSA, PSMA, AMACR, p63, and MSMB and assessed using the h-score method. H-scores in patient matched malignant and benign tissue were correlated with the Gleason grade of the original core and the MRI Likert score for the sampled prostate area. RESULTS A total of 2240 TMA cores were stained and IHC h-scores were assigned to 1790. There was a statistically significant difference in h-scores between patient matched malignant and adjacent benign tissue that is independent of Likert score. There was no association between the h-scores and Gleason grade or Likert score within each of the benign or malignant groups. CONCLUSION The construction of highly selective TMAs from prostate needle biopsy cores is possible. IHC data obtained through this method are highly reliable and can be correlated with imaging. IHC expression patterns for PSA, PSMA, AMACR, p63, and MSMB are distinct in malignant and adjacent benign tissue but did not correlate with mpMRI Likert score.
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Affiliation(s)
- Jonathan Olivier
- Molecular Diagnostics and Therapeutics Group, Charles Bell House, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, Hospital Huriez, University Lille Nord de France, Lille, France
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Vasilis Stavrinides
- Molecular Diagnostics and Therapeutics Group, Charles Bell House, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Jonathan Kay
- Molecular Diagnostics and Therapeutics Group, Charles Bell House, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Alex Freeman
- Department of Pathology, UCLH NHS Foundation Trust, London, United Kingdom
| | - Hayley Pye
- Molecular Diagnostics and Therapeutics Group, Charles Bell House, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Zeba Ahmed
- Molecular Diagnostics and Therapeutics Group, Charles Bell House, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Lina Carmona Echeverria
- Molecular Diagnostics and Therapeutics Group, Charles Bell House, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Susan Heavey
- Molecular Diagnostics and Therapeutics Group, Charles Bell House, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Lucy A M Simmons
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - Abi Kanthabalan
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - Manit Arya
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - Tim Briggs
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
- Department of Urology, The Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Dean Barratt
- Department of Computer Science, Centre for Medical Imaging and Computing, University College London, London, United Kingdom
| | - Susan C Charman
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James Gelister
- Department of Urology, The Royal Free London NHS Foundation Trust, London, United Kingdom
| | - David Hawkes
- Department of Computer Science, Centre for Medical Imaging and Computing, University College London, London, United Kingdom
| | - Yipeng Hu
- Department of Computer Science, Centre for Medical Imaging and Computing, University College London, London, United Kingdom
| | - Charles Jameson
- Department of Pathology, UCLH NHS Foundation Trust, London, United Kingdom
| | - Neil McCartan
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - Shonit Punwani
- Faculty of Medicine, Department of Radiology, UCLH NHS Foundation Trust, London, United Kingdom
| | - Jan van der Muelen
- Department of Pathology, UCLH NHS Foundation Trust, London, United Kingdom
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
| | - Caroline Moore
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - Mark Emberton
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - Hashim U Ahmed
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Hayley C Whitaker
- Molecular Diagnostics and Therapeutics Group, Charles Bell House, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medical Sciences, Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Miah S, Eldred-Evans D, Simmons LAM, Shah TT, Kanthabalan A, Arya M, Winkler M, McCartan N, Freeman A, Punwani S, Moore CM, Emberton M, Ahmed HU. Patient Reported Outcome Measures for Transperineal Template Prostate Mapping Biopsies in the PICTURE Study. J Urol 2018; 200:1235-1240. [PMID: 29940251 DOI: 10.1016/j.juro.2018.06.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Transperineal template prostate mapping biopsy is an increasingly used method of procuring tissue from men with suspected prostate cancer. We report patient related outcome measures and adverse events in men in the PICTURE trial (ClinicalTrials.gov NCT01492270) who underwent this diagnostic test. MATERIALS AND METHODS A total of 249 men underwent multiparametric magnetic resonance imaging followed by transperineal template prostate mapping biopsy as a validation study. Functional outcomes before and after transperineal template prostate mapping were prospectively collected and recorded with questionnaires, including the I-PSS (International Prostate Symptom Score), the I-PSS-QoL (Quality of Life), the IIEF-15 (International Index of Erectile Function-15) and the EPIC (Expanded Prostate Cancer Index Composite) urinary function. RESULTS Mean age was 62 years, median prostate specific antigen was 6.8 ng/ml and median gland size was 37 ml. At transperineal template prostate mapping biopsy a median of 49 cores (IQR 40-55) were taken. Mean time to complete the post-procedure patient related outcome measure questionnaires was 46 days. Adverse events included post-procedure acute urinary retention in 24% of patients, rectal pain in 26% and perineal pain in 41%. Transperineal template prostate mapping biopsy resulted in a statistically significant increase in scores on the I-PSS from 10.9 to 11.8 (p = 0.024) and the I-PSS-QoL from 1.57 to 1.76 (p = 0.03). The IIEF-15 erectile function score decreased by 23.2% from 47.7 to 38.7 (p <0.001). Significant deterioration was noted in all 5 of IIEF-15 functional domains, including erectile and orgasmic function, sexual desire, and intercourse and overall satisfaction (p <0.001). EPIC urinary scores showed no overall change from baseline. CONCLUSIONS Transperineal template prostate mapping biopsy causes a high urinary retention rate and a detrimental impact on genitourinary functional outcomes, including deterioration in urinary flow and sexual function. Our findings can be used to ensure adequate counseling about transperineal template prostate mapping biopsies. The results point to a need for strategies such as multiparametric magnetic resonance imaging and targeted biopsies to minimize the harms of transperineal template prostate mapping biopsy.
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Affiliation(s)
- Saiful Miah
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, Charing Cross, Imperial Healthcare NHS Trust, London, United Kingdom.
| | - David Eldred-Evans
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lucy A M Simmons
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Taimur T Shah
- Department of Urology, Charing Cross, Imperial Healthcare NHS Trust, London, United Kingdom
| | - Abi Kanthabalan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Manit Arya
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Mathias Winkler
- Department of Urology, Charing Cross, Imperial Healthcare NHS Trust, London, United Kingdom
| | - Neil McCartan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Alex Freeman
- Department of Pathology, University College London Hospital, London, United Kingdom
| | - Shonit Punwani
- Department of Radiology, University College London Hospital, London, United Kingdom
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Hashim U Ahmed
- Department of Urology, Charing Cross, Imperial Healthcare NHS Trust, London, United Kingdom; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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Simmons LAM, Kanthabalan A, Arya M, Briggs T, Barratt D, Charman SC, Freeman A, Hawkes D, Hu Y, Jameson C, McCartan N, Moore CM, Punwani S, van der Muelen J, Emberton M, Ahmed HU. Accuracy of Transperineal Targeted Prostate Biopsies, Visual Estimation and Image Fusion in Men Needing Repeat Biopsy in the PICTURE Trial. J Urol 2018; 200:1227-1234. [PMID: 30017964 DOI: 10.1016/j.juro.2018.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE We evaluated the detection of clinically significant prostate cancer using magnetic resonance imaging targeted biopsies and compared visual estimation to image fusion targeting in patients requiring repeat prostate biopsies. MATERIALS AND METHODS The prospective, ethics committee approved PICTURE trial (ClinicalTrials.gov NCT01492270) enrolled 249 consecutive patients from January 11, 2012 to January 29, 2014. Men underwent multiparametric magnetic resonance imaging and were blinded to the results. All underwent transperineal template prostate mapping biopsies. In 200 men with a lesion this was preceded by visual estimation and image fusion targeted biopsies. As the primary study end point clinically significant prostate cancer was defined as Gleason 4 + 3 or greater and/or any grade of cancer with a length of 6 mm or greater. Other definitions of clinically significant prostate cancer were also evaluated. RESULTS Mean ± SD patient age was 62.6 ± 7 years, median prostate specific antigen was 7.17 ng/ml (IQR 5.25-10.09), mean primary lesion size was 0.37 ± 1.52 cc with a mean of 4.3 ± 2.3 targeted cores per lesion on visual estimation and image fusion combined, and a mean of 48.7 ± 12.3 transperineal template prostate mapping biopsy cores. Transperineal template prostate mapping biopsies detected 97 clinically significant prostate cancers (48.5%) and 85 insignificant cancers (42.5%). Overall multiparametric magnetic resonance imaging targeted biopsies detected 81 clinically significant prostate cancers (40.5%) and 63 insignificant cancers (31.5%). In the 18 cases (9%) of clinically significant prostate cancer on magnetic resonance imaging targeted biopsies were benign or clinically insignificant on transperineal template prostate mapping biopsy. Clinically significant prostate cancer was detected in 34 cases (17%) on transperineal template prostate mapping biopsy but not on magnetic resonance imaging targeted biopsies and approximately half was present in nontargeted areas. Clinically significant prostate cancer was found on visual estimation and image fusion in 53 (31.3%) and 48 (28.4%) of the 169 patients (McNemar test p = 0.5322). Visual estimation missed 23 clinically significant prostate cancers (13.6%) detected by image fusion. Image fusion missed 18 clinically significant prostate cancers (10.8%) detected by visual estimation. CONCLUSIONS Magnetic resonance imaging targeted biopsies are accurate for detecting clinically significant prostate cancer and reducing the over diagnosis of insignificant cancers. To maximize detection visual estimation as well as image fusion targeted biopsies are required.
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Affiliation(s)
- Lucy A M Simmons
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom; Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Abi Kanthabalan
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom; Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Manit Arya
- Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Tim Briggs
- Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom; Department of Urology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Dean Barratt
- Centre for Medical Imaging and Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Susan C Charman
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alex Freeman
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - David Hawkes
- Centre for Medical Imaging and Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Yipeng Hu
- Centre for Medical Imaging and Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Charles Jameson
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Neil McCartan
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom; Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline M Moore
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom; Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Jan van der Muelen
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, United Kingdom; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Mark Emberton
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom; Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
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Bass EJ, Freeman A, Jameson C, Punwani S, Moore CM, Arya M, Emberton M, Ahmed HU. Prostate cancer diagnostic pathway: Is a one-stop cognitive MRI targeted biopsy service a realistic goal in everyday practice? A pilot cohort in a tertiary referral centre in the UK. BMJ Open 2018; 8:e024941. [PMID: 30361408 PMCID: PMC6224764 DOI: 10.1136/bmjopen-2018-024941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/24/2018] [Accepted: 09/20/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of a novel multiparametric MRI (mpMRI) and cognitive fusion transperineal targeted biopsy (MRTB) led prostate cancer (PCa) diagnostic service with regard to cancer detection and reducing time to diagnosis and treatment. DESIGN Consecutive men being investigated for possible PCa under the UK 2-week wait guidelines. SETTING Tertiary referral centre for PCa in the UK. PARTICIPANTS Men referred with a raised prostate-specific antigen (PSA) or abnormal digital rectal examination between February 2015 and March 2016 under the UK 2-week rule guideline. INTERVENTIONS An mpMRI was performed prior to patients attending clinic, on the same day. If required, MRTB was offered. Results were available within 48 hours and discussed at a specialist multidisciplinary team meeting. Patients returned for counselling within 7 days PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome measures in this regard included the time to diagnosis and treatment of patients referred with a suspicion of PCa. Quality control outcome measures included clinically significant and total cancer detection rates. RESULTS 112 men were referred to the service. 111 (99.1%) underwent mpMRI. Median PSA was 9.4 ng/mL (IQR 5.6-21.0). 87 patients had a target on mpMRI with 25 scoring Likert 3/5 for likelihood of disease, 26 4/5 and 36 5/5.57 (51%) patients received a local anaesthetic, Magnetic resonance imaging targeted biopsy (MRTB). Cancer was detected in 45 (79%). 43 (96%) had University College London definition 2 disease or greater. The times to diagnosis and treatment were a median of 8 and 20 days, respectively. CONCLUSIONS This approach greatly reduces the time to diagnosis and treatment. Detection rates of significant cancer are high. Similar services may be valuable to patients with a potential diagnosis of PCa.
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Affiliation(s)
- Edward James Bass
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Charles Jameson
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Medicine, Centre for Medical Imaging, University College London, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manit Arya
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hashim Uddin Ahmed
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Abstract
SummaryAntithrombin III activity and thrombin times were assayed in maturity onset diabetics, atherosclerotic patients and normal subjects. There was a close correlation between the Antithrombin III activity and thrombin times in all three groups. Reductions in these measurements in diabetes mellitus and atherosclerosis, independent of thromboembolic phenomena, support the theory of Antithrombin III deficiency in these diseases.
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Guillaumier S, Peters M, Arya M, Afzal N, Charman S, Dudderidge T, Hosking-Jervis F, Hindley RG, Lewi H, McCartan N, Moore CM, Nigam R, Ogden C, Persad R, Shah K, van der Meulen J, Virdi J, Winkler M, Emberton M, Ahmed HU. A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer. Eur Urol 2018; 74:422-429. [PMID: 29960750 PMCID: PMC6156573 DOI: 10.1016/j.eururo.2018.06.006] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 06/01/2018] [Indexed: 12/15/2022]
Abstract
Background Clinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects. Objective To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate. Design, setting, and participants This was a prospective study of 625 consecutive patients with nonmetastatic clinically significant PCa undergoing focal HIFU therapy (Sonablate) in secondary care centres between January 1, 2006 and December 31, 2015. A minimum of 6-mo follow-up was available for599 patients. Intermediate- or high-risk PCa was found in 505 patients (84%). Intervention Disease was localised using multiparametric magnetic resonance imaging (mpMRI) combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included prostate-specific antigen (PSA) measurement, mpMRI, and biopsies. Outcome measurements and statistical analysis The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality. Results and limitations The median follow-up was 56 mo (interquartile range [IQR] 35–70). The median age was 65 yr (IQR 61–71) and median preoperative PSA was 7.2 ng/ml (IQR 5.2–10.0). FFS was 99% (95% confidence interval [CI] 98–100%) at 1 yr, 92% (95% CI 90–95%) at 3 yr, and 88% (95% 85–91%) at 5 yr. For the whole patient cohort, metastasis-free, cancer-specific, and overall survival at 5 yr was 98% (95% CI 97–99%), 100%, and 99% (95% CI 97–100%), respectively. Among patients who returned validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than 1 pad/d. Limitations include the lack of long-term follow-up. Conclusions Focal therapy for select patients with clinically significant nonmetastatic prostate cancer is effective in the medium term and has a low probability of side effects. Patient summary In this multicentre study of 625 patients undergoing focal therapy using high-intensity focused ultrasound (HIFU), failure-free survival, metastasis-free survival, cancer-specific survival, and overall survival were 88%, 98%, 100%, and 99%, respectively. Urinary incontinence (any pad use) was 2%. Focal HIFU therapy for patients with clinically significant prostate cancer that has not spread has a low probability of side effects and is effective at 5 yr.
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Affiliation(s)
- Stephanie Guillaumier
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Max Peters
- Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands
| | - Manit Arya
- Department of Urology, UCLH NHS Foundation Trust, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Naveed Afzal
- Department of Urology, Dorset County Hospital NHS Trust, Dorset, UK
| | - Susan Charman
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Feargus Hosking-Jervis
- Division of Surgery and Interventional Sciences, University College London, London, UK; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | | | - Neil McCartan
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Raj Nigam
- Department of Urology, Royal County Surrey Hospital NHS Trust, Guildford, UK
| | - Chris Ogden
- Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Raj Persad
- Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Karishma Shah
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | | | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Mathias Winkler
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Sciences, University College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
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Shah TT, Peters M, Guillaumier S, Arya M, Afzal N, Hosking-Jervis F, Dudderidge T, Hindley R, Lewi H, McCartan N, Moore CM, Nigam R, Ogden C, Persad R, Shah K, Virdi J, Winkler M, Emberton M, Ahmed HU, Minhas S. MP30-11 PREDICTORS OF POOR FUNCTIONAL OUTCOMES AFTER FOCAL HIGH INTENSITY FOCUSSED ULTRASOUND (HIFU). J Urol 2018. [DOI: 10.1016/j.juro.2018.02.952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Huber PM, Afzal N, Arya M, Boxler S, Charman S, Cornaby A, Dudderidge T, Emberton M, Guillaumier S, Hindley RJ, Leemann L, Lewi H, McCartan N, Moore CM, Nigam R, Ogden C, Persad R, Shah K, Thalmann GN, Virdi J, Winkler M, Ahmed HU. MP30-10 HIFU DOSE ESCALATION LEADS TO FEWER RECURRENCES IN FOLLOWING FOCAL HIFU IN PROSTATE CANCER. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Huber PM, Afzal N, Arya M, Boxler S, Charman S, Cornaby A, Dudderidge T, Emberton M, Guillaumier S, Hindley RJ, Leemann L, Lewi H, McCartan N, Moore CM, Nigam R, Ogden C, Persad R, Shah K, Thalmann GN, Virdi J, Winkler M, Ahmed HU. PD34-07 PSA FAILS TO PREDICT TREATMENT FAILURE IN FOCAL HIGH-INTENSITY FOCUSED ULTRASOUND THERAPY IN PROSTATE CANCER. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shah TT, Gao C, O' Keefe A, Manning T, Peacocke A, Cashman S, Nambiar A, Lamb B, Cumberbatch M, Ivin N, Maw J, Ali Abdaal C, Al Hayek S, Christidis D, Bolton D, Lawrentschuk N, Khan S, Demirel S, Graham S, Lee JCM, Evans S, Koschel S, Badgery H, Brennan J, Wang L, Nzenza T, Ruljancich P, Begum R, Hamad S, Shetty A, Swallow D, Jessica S M, Curry D, Young M, Abboudi H, Jalil R, Dasgupta R, Cameron F, Shingles C, Ho C, Parwaiz I, Henderson J, Mackenzie KR, Reid K, Umeni-Eronini N, Assaf N, Oyekan A, Sriprasad S, Hayat Z, Morrison-Jones V, Steen C, Alberto M, Rujancich P, Laird A, Sharma A, Phipps S, Harris A, Rogers A, Ngweso S, Nyandoro M, Hayne D, Hendry J, Kerr L, Mcilhenny C, Rodger F, Docherty E, Ng A, Seaward L, Eldred-Evans D, Bultitude M, Abdelmoteleb H, Hawary A, Tregunna R, Ibrahim H, Mc Grath S, O’ Brien J, Campbell A, Cronbach P, Paget A, Suraparaj L, O' Brien J, Gupta SK, Tait C, Sakthivel A, Pankhania R, Al-Qassim Z, Rezacova M, Edison E, Sandhu S, Foley R, Akintimehin A, Khan A, Nkwam N, Grice P, Khan M, Kashora F, Manson-Bahr D, Mc Cauley N, Nehikhare O, Bycroft J, Tailor K, Saleemi A, Al-Dhahir W, Abu Yousif M, O' Rourke J, Chin AOL, Pearce I, Olivier J, Tay J, Cannon A, Akman J, Hussain Z, Coode-Bate J, Natarajan M, Irving S, Murtagh K, Carrie A, Miller M, Malki M, Burge F, Ratan H, Bedi N, Kavia R, Stonier T, Simson N, Singh H, Hatem E, Arya M, Sadien I, Miakhil I, Sharma S, Olaniyi P, Stammeijer R, Mason H, Symes A, Lavan L, Rowbotham C, Wong C, Al-Shakhshir S, Belal M, Mc Kay AC, Graham J, Simmons L, Khadouri S, Withington J, Ajayi L, Ajayi L, Tay LJ, Ward A, Parys B, Liew M, Simpson R, Ross D, Adams R, Mirza AB, Acher P, Gallagher M, Premakumar Y, Ager M, Ayres B, Pang K, Patterson J, Kozan AA, Jaffer A, Din W, Biyani CS, Tam JPH, Tudor E, Probert JL, Matanhelia M, Hegazy M, Quinlan D, Ness D, Gowardhan B, Bateman K, Wozniak S, Ellis G, Smith D, Derbyshire L, Chow K, Mosey R, Osman B, Kynaston H, Clements J, Hann G, Gray S, Yassaie O, Weeratunga G, Udovicich C, Mbuvi J, Stewart H, Samsudin A, Hughes-Hallet A, Kum F, Symes R, Frymann R, Chappell B, Rezvani S, Ahmed I, Shergill I, Lee SM, Hussain A, Pickard R, Erotocritou P, Smith D, Kasivisvanathan V. PD17-08 THE EFFECTS OF MEDICALLY EXPULSIVE THERAPY (MET) ON SPONTANEOUS STONE PASSAGE (SSP) IN PATIENTS PRESENTING WITH ACUTE URETERIC COLIC. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gemma Hann
- Belfast, Northern Ireland, United Kingdom
| | - Sam Gray
- Belfast, Northern Ireland, United Kingdom
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Huber P, Afzal N, Arya M, Boxler S, Charman S, Cornaby A, Dudderidge T, Emberton M, Guillaumier S, Hindley R, Leemann L, Lewi H, Mc Cartan N, Moore C, Nigam R, Ogden C, Persad R, Shah K, Thalmann G, Virdi J, Winkler M, Ahmed H. Focal HIFU: Higher recurrence rate in treatment of anterior compared to posterior lesions in prostate cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31383-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chau EM, Arya M, Petrides N, Aldin Z, McKenzie J, Emberton M, Virdi J, Ahmed HU, Kasivisvanathan V. Performance characteristics of multiparametric-MRI at a non-academic hospital using transperineal template mapping biopsy as a reference standard. International Journal of Surgery Open 2018. [DOI: 10.1016/j.ijso.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Affiliation(s)
- M Harper
- Institute of Urology, 48 Riding House Street, London W1W 7EY, UK
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Affiliation(s)
- Simon R J Bott
- Institute of Urology and Nephrology, 67 Riding House Street, London W1W 7EY, UK
| | - Iqbal Shergill
- Institute of Urology and Nephrology, 67 Riding House Street, London W1W 7EY, UK
| | - Manit Arya
- Institute of Urology and Nephrology, 67 Riding House Street, London W1W 7EY, UK
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Affiliation(s)
- J S Kalsi
- Institute of Urology and Nephrology, 48 Riding House Street, London W1P 7NN, UK.
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