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

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

6. 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

7. 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

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

9. 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

10. Multiparametric MRI
Template Biopsy

12. THE UCL FOCAL PROGRAMME
T1-weighted with gadolinium enhancement

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

14. RESULTS
p=0.004
p=0.153

15. 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%

16. 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