Patients who undergo focal therapy for prostate cancer (PCa) using high-intensity focused ultrasound (HIFU) experience good survival over 5 years, according to new study findings published in European Urology.
The study of 625 patients (median age 65 years; PSA 7.2 ng/mL) from 9 centers is the largest and longest investigation of HIFU to date, according to lead author Hashim U. Ahmed, PhD, BM BCh, of University College London, and colleagues.
At a median of 56 months, failure-free, metastasis-free, cancer-specific, and overall survival were 88%, 98%, 100%, and 99%, respectively. Failure-free survival included freedom from radical or systemic therapy, metastases, and cancer-specific mortality. Following focal HIFU, 8 patients required salvage radical prostatectomy, 36 required salvage external beam radiotherapy, and 1 required androgen deprivation therapy. Metastases developed in 10 patients.
HIFU was associated with few side effects. Just 2% of men experienced urinary incontinence requiring pad use.
“Focal therapy using HIFU could be offered to select patients with clinically significant nonmetastatic prostate cancer as it is effective in the medium term and has a low probability of urinary and rectal side effects,” Dr Ahmed’s team concluded.
Focal HIFU treatment was offered to patients diagnosed with Gleason 6 to 9, stage T1c – 3bN0M0 PCa and a PSA level of 30 ng/mL or less. Men with Gleason 6 disease required a minimum of 4 mm of cancer.
Eighty-four percent of patients had intermediate- or high-risk PCa at baseline. Prior to HIFU, health care providers used multiparametric magnetic resonance imaging (mpMRI) combined with targeted and systematic biopsies, or transperineal mapping biopsies to identify areas of disease.
The study was funded by the Medical Research Council and SonaCare Inc., which manufactures HIFU equipment.
Guillaumier S, Peters M, Arya M, et al. A Multicentre Study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. Eur Urol. DOI: 10.1016/j.eururo.2018.06.006 [Published online June 27, 2018]