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Peer-reviewedCC BYEuropean Urology

Oncological Outcomes Following Focal HIFU and Cryotherapy for Treatment of Nonmetastatic Prostate Cancer in the United Kingdom: An Updated Analysis of 3477 Patients from the Prospective HEAT and ICE Registries

  • Alexander Light1
  • Max Peters2
  • Archana Gopalakrishnan3
  • Nikhil Mayor3
  • Emma Cullen4
  • Ranil Johann Boaz3
  • Joseph Michael Norris3
  • Samuel Morris3
  • Manit Arya3
  • Mariana Bertoncelli Tanaka3
  • Alan P Doherty5
  • Tim J. Dudderidge6
17 more authors
  • Amr Emara7
  • Mark Emberton8
  • Alistair Grey8
  • Richard Graham Hindley7
  • Marc Laniado9
  • Stuart McCraken10
  • Caroline M. Moore8
  • Raj Nigam11
  • Mohamed Essam Noureldin7
  • Clément Orczyk8
  • Arnas Rakauskas3
  • Lucy A. M. Simmons12
  • Jaspal Singh Virdi13
  • John Withington8
  • Paimaun Zakikhani14
  • Hashim Uddin Ahmed3
  • Taimur Tariq Shah3
14 affiliations
  1. 1Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: [email protected]
  2. 2Radiotherapiegroep, Deventer, The Netherlands
  3. 3Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
  4. 4Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
  5. 5Department of Urology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  6. 6Department of Urology, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  7. 7Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
  8. 8Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
  9. 9Department of Urology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
  10. 10Department of Urology, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, London, UK
  11. 11Department of Urology, Royal Surrey County Hospital, Royal Surrey NHS Foundation Trust, Guildford, UK
  12. 12Department of Urology, Royal United Hospital, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
  13. 13Department of Urology, Princess Alexandra Hospital, The Princess Alexandra Hospital NHS Trust, Harlow, UK
  14. 14Department of Urology, Princess Royal Hospital, University Hospitals Sussex NHS Foundation Trust, Haywards Heath, UK
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Abstract

BACKGROUND AND OBJECTIVE: Long-term outcome data for focal therapy using high-intensity focused ultrasound (HIFU) or cryotherapy for nonmetastatic prostate cancer are needed. We report 10-yr cancer control outcomes. METHODS: Patients with nonmetastatic prostate cancer who underwent primary focal HIFU or cryotherapy and had at least 6 mo follow-up were identified from the UK HIFU Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) prospectively maintained registries. The intervention included up to two focal ablative sessions. The primary outcome was cancer-specific mortality. Secondary outcomes were all-cause mortality, metastasis, local retreatment, radical treatment, and androgen-deprivation therapy (ADT) use. KEY FINDINGS AND LIMITATIONS: A total of 3477 patients (HIFU: n = 2897; cryotherapy: n = 580) were included from 14 UK centres (2004-2024). A total of 48%, 23%, and 25% had European Association of Urology (EAU) 2025-version favourable intermediate-, unfavourable-intermediate-, and high-risk disease, respectively. Ten-yr cancer-specific mortality was 0.13% (95% confidence interval [CI] = 0.027-0.45%). Ten-yr all-cause mortality and metastases were 12% (95% CI = 8.8-15%) and 3.3% (95% CI = 2.1-4.9%), respectively. Ten-yr ADT use was 14% (95% CI = 11-17%). Ten-yr local retreatment and radical treatment were 33% (95% CI = 30-37%) and 30% (95% CI = 27-34%), respectively, on an intention-to-treat basis. In a post hoc per-protocol analysis, undertaken to estimate outcomes under stricter adherence to the two focal ablative session protocol, patients who underwent radical treatment despite being potentially eligible for a further focal ablative session were censored at the time of radical treatment; 10-yr local retreatment and radical treatment were 13% (95% CI = 11-16%) and 8.9% (95% CI = 6.9-11%), respectively. The observational study design is the main limitation. CONCLUSIONS AND CLINICAL IMPLICATIONS: Focal therapy using up to two sessions of focal HIFU or cryotherapy could be considered as a first-line treatment for well-selected patients of nonmetastatic prostate cancer alongside radical treatment. Future research priorities should include the development of a dedicated prognostic risk calculator, further prospective assessment of focal therapy for high-risk disease, and improvements in the detection and management of locally recurrent disease.

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Cite

BibTeXRIS
BibTeX
@article{light2026oncological,
  title = {{Oncological Outcomes Following Focal HIFU and Cryotherapy for Treatment of Nonmetastatic Prostate Cancer in the United Kingdom: An Updated Analysis of 3477 Patients from the Prospective HEAT and ICE Registries}},
  author = {Alexander Light and Max Peters and Archana Gopalakrishnan and Nikhil Mayor and Emma Cullen and Ranil Johann Boaz and Joseph Michael Norris and Samuel Morris and Manit Arya and Mariana Bertoncelli Tanaka and Alan P Doherty and Tim J. Dudderidge and Amr Emara and Mark Emberton and Alistair Grey and Richard Graham Hindley and Marc Laniado and Stuart McCraken and Caroline M. Moore and Raj Nigam and Mohamed Essam Noureldin and Clément Orczyk and Arnas Rakauskas and Lucy A. M. Simmons and Jaspal Singh Virdi and John Withington and Paimaun Zakikhani and Hashim Uddin Ahmed and Taimur Tariq Shah},
  journal = {European Urology},
  year = {2026},
  month = jul,
  doi = {10.1016/j.eururo.2026.05.007},
  url = {https://doi.org/10.1016/j.eururo.2026.05.007},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Oncological Outcomes Following Focal HIFU and Cryotherapy for Treatment of Nonmetastatic Prostate Cancer in the United Kingdom: An Updated Analysis of 3477 Patients from the Prospective HEAT and ICE Registries
AU  - Alexander Light
AU  - Max Peters
AU  - Archana Gopalakrishnan
AU  - Nikhil Mayor
AU  - Emma Cullen
AU  - Ranil Johann Boaz
AU  - Joseph Michael Norris
AU  - Samuel Morris
AU  - Manit Arya
AU  - Mariana Bertoncelli Tanaka
AU  - Alan P Doherty
AU  - Tim J. Dudderidge
AU  - Amr Emara
AU  - Mark Emberton
AU  - Alistair Grey
AU  - Richard Graham Hindley
AU  - Marc Laniado
AU  - Stuart McCraken
AU  - Caroline M. Moore
AU  - Raj Nigam
AU  - Mohamed Essam Noureldin
AU  - Clément Orczyk
AU  - Arnas Rakauskas
AU  - Lucy A. M. Simmons
AU  - Jaspal Singh Virdi
AU  - John Withington
AU  - Paimaun Zakikhani
AU  - Hashim Uddin Ahmed
AU  - Taimur Tariq Shah
PY  - 2026
DA  - 2026/07/01
JO  - European Urology
DO  - 10.1016/j.eururo.2026.05.007
UR  - https://doi.org/10.1016/j.eururo.2026.05.007
AB  - BACKGROUND AND OBJECTIVE: Long-term outcome data for focal therapy using high-intensity focused ultrasound (HIFU) or cryotherapy for nonmetastatic prostate cancer are needed. We report 10-yr cancer control outcomes. METHODS: Patients with nonmetastatic prostate cancer who underwent primary focal HIFU or cryotherapy and had at least 6 mo follow-up were identified from the UK HIFU Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) prospectively maintained registries. The intervention included up to two focal ablative sessions. The primary outcome was cancer-specific mortality. Secondary outcomes were all-cause mortality, metastasis, local retreatment, radical treatment, and androgen-deprivation therapy (ADT) use. KEY FINDINGS AND LIMITATIONS: A total of 3477 patients (HIFU: n = 2897; cryotherapy: n = 580) were included from 14 UK centres (2004-2024). A total of 48%, 23%, and 25% had European Association of Urology (EAU) 2025-version favourable intermediate-, unfavourable-intermediate-, and high-risk disease, respectively. Ten-yr cancer-specific mortality was 0.13% (95% confidence interval [CI] = 0.027-0.45%). Ten-yr all-cause mortality and metastases were 12% (95% CI = 8.8-15%) and 3.3% (95% CI = 2.1-4.9%), respectively. Ten-yr ADT use was 14% (95% CI = 11-17%). Ten-yr local retreatment and radical treatment were 33% (95% CI = 30-37%) and 30% (95% CI = 27-34%), respectively, on an intention-to-treat basis. In a post hoc per-protocol analysis, undertaken to estimate outcomes under stricter adherence to the two focal ablative session protocol, patients who underwent radical treatment despite being potentially eligible for a further focal ablative session were censored at the time of radical treatment; 10-yr local retreatment and radical treatment were 13% (95% CI = 11-16%) and 8.9% (95% CI = 6.9-11%), respectively. The observational study design is the main limitation. CONCLUSIONS AND CLINICAL IMPLICATIONS: Focal therapy using up to two sessions of focal HIFU or cryotherapy could be considered as a first-line treatment for well-selected patients of nonmetastatic prostate cancer alongside radical treatment. Future research priorities should include the development of a dedicated prognostic risk calculator, further prospective assessment of focal therapy for high-risk disease, and improvements in the detection and management of locally recurrent disease.
SN  - 0302-2838
SN  - 1421-993X
SN  - 1873-7560
ER  -