Whole gland high-intensity focused ultrasound (HIFU) therapy is less effective than radical prostatectomy in controlling prostate cancer (PCa), except in men with low-risk disease, according to long-term results from a new study.

In a cohort of patients with localized PCa from a single institution, 418 underwent open retropubic radical prostatectomy (RP) and 469 whole gland HIFU. At 10 years, the RP group had better survival outcomes than the HIFU group, Bernd Rosenhammer, MD, of the University of Regensburg in Germany, and collaborators reported in the World Journal of Urology:

  • Overall survival (OS): 91% vs 76%, respectively
  • Cancer-specific survival (CSS): 98% vs 94%, respectively
  • Biochemical failure-free survival (BFS): 80% vs 70%, respectively
  • Salvage treatment-free survival (STS): 80% vs 71%, respectively

In a multivariable Cox regression analysis, HIFU therapy significantly and independently predicted inferior OS, CSS, and STS. In subgroup analysis of CSS, HIFU was no worse than RP in the low-risk group, but proved inferior in the intermediate- and high-risk groups.

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Study results confirm previous findings of adequate long-term cancer control by HIFU for low- and intermediate-risk patients, according to Dr Rosenhammer’s team. “For the subgroup of intermediate-risk patients, CSS rates seem to be comparable up to 10 years suggesting that HIFU may be an alternative for older patients, although a higher risk of salvage treatment should be expected.”

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Rosenhammer B, Ganzer R, Zeman F, et al. Oncological long‑term outcome of whole gland HIFU and open radical prostatectomy: a comparative analysis. World J Urol 37:2073-2080. doi:10.1007/s00345-018-2613-z