Division of Interventional Science University College of London Dr Alberto Gritti Director: Mark Emberton 1

“Radical prostatectomy did not significantly reduce all cause or prostate cancer specific mortality as compared with observation”

TISSUE-PRESERVING STRATEGIES “If the opportunity to benefit is small so too must be the harms that come with the treatment” (M. Emberton) TISSUE-PRESERVING STRATEGIES

Focal Therapy as the Potential Solution Scepticism – Multifocality 80% Focal therapy may decrease the number of side effects while maintaining the benefit of treatment Novel imaging and precision biopsy can identify those lesions that are likely to progress Selective therapy to Clinically Significant lesions alone Scepticism – Multifocality 80% 7

Does an Index Lesion Exist? A Biological Approach These Lesions do not meet the criteria for Cancer Might be classified as non malignant

Which Ablative Strategy in Localised Prostate Cancer is best for Erectile Function preservation? Gritti A*, Legramanti S* ., Valerio M, Mccartan N, Dickinson L, Ahmed HU, Emberton M HYPOTHESIS Erectile Function preservation is related to the extent of prostatic tissue ablation using High-Intensity Focused Ultrasound (HIFU) in Prostate Cancer METHODS Registry-based analysis of Erectile Function before and after HIFU 169 pz Outcome measure= Δ IIEF-15 and % Penetrative Intercourse Whole-gland HIFU Hemi-ablation HIFU Focal HIFU

Multiparametric MRI Template Biopsy

THE UCL FOCAL PROGRAMME T1-weighted with gadolinium enhancement

THE UCL FOCAL PROGRAMME T1-weighted gadolinium enhancement at 1 week post Left Hemi-HIFU

RESULTS p=0.004 p=0.153

Residual Disease (any) 4-50% Significant Residual Disease 0-17% Results Value Follow-up 0-11 years Residual Disease (any) 4-50% Significant Residual Disease 0-17% Urinary Outcome (Pad-free continence) 95-100% Erectile Outcome (Penetrative Intercourse) 54-100% Recto-Urethral Fistula 0-1%

CONCLUSIONS The type of Ablative Strategy seems to have an impact on Erectile Function Comparative trials in an homogeneous population are needed to confirm these findings