Focal ablation of prostate cancer (PCa) tumors with high-intensity focused ultrasound (HIFU) is safe and provides excellent potency and continence preservation with adequate short-term cancer control, investigators concluded based on initial results from the first and largest focal HIFU series in the United States.
Radical treatment was avoided in 91% of patients at 2 years, Andre Luis Abreu, MD, of the University of Southern California in Los Angeles, California, and colleagues reported in The Journal of Urology.
The investigators studied 100 consecutive men who underwent hemigland HIFU treatment. The primary endpoint was treatment failure, defined as Grade Group 2 or higher disease on follow-up prostate biopsy, radical treatment, systemic therapy, metastases, or cancer-specific mortality.
At study entry, 8% and 20% of patients had very-low-risk PCa and low-risk PCa, respectively, and 50%, 17%, and 5% had intermediate favorable-, intermediate unfavorable-, and high-risk PCa, respectively. Patients had a median follow-up of 20 months. The 2-year survival rates of freedom from treatment failure, Grade Group 2 or greater recurrence, repeat focal HIFU, and radical treatment were 73%, 76%, 90%, and 91%, respectively.
Of the 58 men who underwent post-treatment biopsy, 10 had in-field and 8 out-of-field Grade Group 2 or higher positive biopsies, according to the investigators.
Continence (defined as the need for no pads) was maintained in all patients. Patients experienced no diminishment in erectile function, with median International Index of Erectile Function-5 scores before and after HIFU treatment not differing significantly (22 vs 21; P =.99), Dr Abreu’s team reported. The median International Prostate Symptom Score improved significantly, decreasing from 9 before treatment to 6 after treatment (P =.005). No patient died or had a rectal fistula.
Limitations of the study included its retrospective design, short follow-up duration, and relatively small study population.
Abreu AL, Peretsman S, Iwata A, et al. High intensity focused ultrasound hemigland ablation for prostate cancer: initial outcomes of a United States series. J Urol. 204:71-747. doi:10.1097/JU.0000000000001126