METHODS: Over 8 years, men with localized prostate cancer treated with whole-gland HIFU were prospectively followed. Transrectal prostate ablation was performed under general anesthesia with Sonablate-500® (Sonacare Medical©, Charlotte, North Carolina, USA). The primary outcome was failure-free survival defined as no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included both survival outcomes and QoL measures.
RESULTS: Of 70 men, 29.7% had International Society of Urological Pathology (ISUP) grade 1, 43.8% ISUP 2, 10.9% ISUP 3, and 15.6% ISUP 4 disease. At median follow-up of 83.4 months, overall mortality was 8.6% and prostate cancer-specific mortality 0%. Failure-free survival was 78.2% at 5 years and 71.2% at 7 years. Of all men, 7.1% of men developed metastases, with median metastasis-free survival of 75.4 months. There was negligible post-HIFU urinary incontinence or lower urinary tract symptom with a median Male Urogenital Distress Inventory score of 32 at 6 months and 33 at 12 months and median IPSS of 4 at 6 months and 3 at 12 months. Median Radiation Therapy Oncology Group rectal toxicity score was 0 throughout. In men who had mild or no erectile dysfunction at baseline (International Index of Erectile Function ≥17), the mean International Index of Erectile Function score declined to 37% from 23.5 at baseline to 14.7 at 12 months.
CONCLUSION: At median follow-up of 7 years, whole-gland HIFU appears to have comparable survival outcomes with other cohort studies involving radical prostatectomy and radiotherapy patient. It has low impact on QoL, preserved urinary continence, and erectile function approximate to nerve-sparing prostatectomy. Whole-gland HIFU presents a potential alternative minimally invasive and safe option for the treatment of localized prostate cancer.
METHODS: Data from the Asia-Pacific Lupus Collaboration cohort were analyzed (2013-2021). Mucocutaneous activity (MC-A) items were rash, alopecia, and mucosal ulcers; were defined by the Systemic Lupus Erythematosus Disease Activity Index 2000; and were persistent if present for at least six months. Mucocutaneous damage (MC-D) items were chronic skin ulceration, scarring alopecia, and skin/panniculum scarring and were defined by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. HRQoL was measured by 36-Item Short Form Health Survey (SF-36) surveys. Multivariate logistic generalized estimating equation models were used to determine correlates of MC-A at each visit. Time-varying covariate survival models were used to determine predictors of MC-D.
RESULTS: During a median of 2.5 (interquartile range 1.0-5.1) years' follow-up, 1,499 of 4,102 patients (36.5%) had MC-A (rash n = 1,055, alopecia n = 731, mucosal ulcers n = 352) and 606 of 3,655 patients (16.6%) had persistent MC-A. These patients were more likely to record worse mean mental (42.6 vs 44.8; P = 0.014) and physical component (41.1 vs 46.1; P