High intensity focused ultrasound (HIFU) for prostate cancer: a national cohort study focusing on long term stricture and fistula
BAUS ePoster online library. Dosanjh A. Jun 24, 2019; 259544; P5-14 Disclosure(s): I declare no conflict of interest
Dr. Amandeep Dosanjh
Dr. Amandeep Dosanjh
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Abstract
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INTRODUCTION:
Long term data for HIFU outcomes is lacking; therefore, NICE currently only recommends its use in 'the context of controlled clinical trials'. The aim of this study is to evaluate the risks of stricture and fistula.

Materials and methods:
HIFU treatments for prostate cancer between April 2007 and March 2018 were identified in Hospital Episode Statistics (HES).

Results:

2320 HIFU treatments for 1990 patients were identified. 28/50 (56%) centres performed less than 6 procedures over the study period. 1513, 194 and 613 procedures were performed by the largest volume, second largest and remaining 48 centres respectively. Less than 850 patients have been included in published clinical trials since 2007. Median age was 67 (IQR 61-72). There were no co-morbidities for 82.9% occurrences. 1742 patients, with ≥1 year follow-up, were included in the analysis. HIFU as salvage therapy was given in 3.4% cases. Salvage prostatectomy (RP) and radiotherapy (RT) was administered in 5.9% and 11.9% patients respectively (18% total). For the pure HIFU cohort, rates of stricture and urinary fistula were 10.7% and 1.3% respectively.

Conclusion:
HIFU as an intervention may potentially allow a longer period of what would have been active surveillance. Appropriate counselling of patients must include the risks of treatment, ideally in a clinical trial setting as recommended by NICE and the EAU, given we have observed over 50% of patients treated with HIFU in England have been outside of a published trial.
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