Max Peters1, Abi Kanthabalan2, Taimur T Shah3, Neil McCartan2, Caroline M Moore2, Manit Arya4, Jochem R van der Voort van Zyp5, Marinus A Moerland5, Richard G Hindley6, Mark Emberton7, Hashim U Ahmed8. 1. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: M.Peters-10@umcutrecht.nl. 2. Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK. 3. Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK; Department of Urology, Whittington Hospital NHS Trust, London, UK. 4. Department of Urology, UCLH NHS Foundation Trust, London, UK; Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK. 5. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. 6. Department of Urology, Basingstoke Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK. 7. Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, Whittington Hospital NHS Trust, London, UK; NIHR UCLH/UCL Comprehensive Biomedical Research Center, London, UK. 8. Division of Surgery and Interventional Science, University College London, London, UK; Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Imperial Urology, Imperial Healthcare NHS Trust, London, UK.
Abstract
PURPOSE: Patient selection for focal salvage remains difficult. Therefore, we developed and internally validated prediction models for biochemical failure (BF) and a composite endpoint (CE) following focal salvage high intensity focused ultrasound (HIFU) for radiorecurrent prostate cancer. MATERIALS AND METHODS: A prospective HIFU registry identified 150 cases (November 2006-August 2015). Recurrence was assessed with multiparametric magnetic resonance imaging (MRI) combined with template prostate mapping biopsies, targeted biopsies, or systematic transrectal ultrasound-guided biopsies. Metastatic disease was ruled out with a positron emission tomography-computed tomography and a bone scan. Focal salvage HIFU consisted of quadrant-ablation, hemi-ablation, or index-lesion ablation. Cox-regression was used for BF (Phoenix-definition) and CE (BF/MRI+/biopsies+/local or systemic treatment/metastases+/prostate cancer specific mortality+). Internal validation was performed using bootstrap resampling (500 datasets) after which C-statistic and hazard ratios were adjusted. Models were calibrated and risk scores created. RESULTS: Median follow-up was 35 months (interquartile range: 22-52). Median biochemical disease-free survival (DFS) was 33 months (95% CI: 23-45). Median CE-free survival was 24 months (95% CI: 21-35). After multivariable analysis, DFS interval after primary radiotherapy, presalvage prostate-specific antigen (PSA), PSA-doubling time, prostatic volume, and T-stage (both MRI based) predicted BF. For the CE, PSA-doubling time was not predictive but additionally, primary Gleason score was. The adjusted C-statistics were 0.68 and 0.64 for BF and CE, respectively. Calibration was accurate until 48 months. The risk scores showed 3 groups, with biochemical DFS of 60%, 35%, and 7% and CE-free survival of 40%, 24%, and 0% at 4 years. CONCLUSION: Our model, once externally validated, could allow for better selection of patients for focal salvage HIFU. Crown
PURPOSE:Patient selection for focal salvage remains difficult. Therefore, we developed and internally validated prediction models for biochemical failure (BF) and a composite endpoint (CE) following focal salvage high intensity focused ultrasound (HIFU) for radiorecurrent prostate cancer. MATERIALS AND METHODS: A prospective HIFU registry identified 150 cases (November 2006-August 2015). Recurrence was assessed with multiparametric magnetic resonance imaging (MRI) combined with template prostate mapping biopsies, targeted biopsies, or systematic transrectal ultrasound-guided biopsies. Metastatic disease was ruled out with a positron emission tomography-computed tomography and a bone scan. Focal salvage HIFU consisted of quadrant-ablation, hemi-ablation, or index-lesion ablation. Cox-regression was used for BF (Phoenix-definition) and CE (BF/MRI+/biopsies+/local or systemic treatment/metastases+/prostate cancer specific mortality+). Internal validation was performed using bootstrap resampling (500 datasets) after which C-statistic and hazard ratios were adjusted. Models were calibrated and risk scores created. RESULTS: Median follow-up was 35 months (interquartile range: 22-52). Median biochemical disease-free survival (DFS) was 33 months (95% CI: 23-45). Median CE-free survival was 24 months (95% CI: 21-35). After multivariable analysis, DFS interval after primary radiotherapy, presalvage prostate-specific antigen (PSA), PSA-doubling time, prostatic volume, and T-stage (both MRI based) predicted BF. For the CE, PSA-doubling time was not predictive but additionally, primary Gleason score was. The adjusted C-statistics were 0.68 and 0.64 for BF and CE, respectively. Calibration was accurate until 48 months. The risk scores showed 3 groups, with biochemical DFS of 60%, 35%, and 7% and CE-free survival of 40%, 24%, and 0% at 4 years. CONCLUSION: Our model, once externally validated, could allow for better selection of patients for focal salvage HIFU. Crown
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Authors: Marnix Rasing; Marieke van Son; Marinus Moerland; Bart de Keizer; Frank Wessels; Trudy Jonges; Sandrine van de Pol; Wietse Eppinga; Juus Noteboom; Jan Lagendijk; Jochem van der Voort van Zijp; Max Peters Journal: Cancers (Basel) Date: 2022-02-03 Impact factor: 6.639
Authors: Thomas Willigenburg; Marieke J van Son; Sandrine M G van de Pol; Wietse S C Eppinga; Jan J W Lagendijk; Hans C J de Boer; Marinus A Moerland; Jochem R N van der Voort van Zyp; Max Peters Journal: Clin Transl Radiat Oncol Date: 2021-06-29