High-intensity focused ultrasound (HIFU) hemiablation offers mid-term promising functional and oncologic outcomes in carefully selected patients with clinically localized prostate cancer (PCa), according to researchers.
In a prospective cohort study of 50 patients who underwent HIFU ablation of a single lobe of the prostate, the 5-year actuarial metastases-free survival, cancer-specific survival, and overall survival rates were 93%, 100%, and 87%, respectively, Roland van Velthoven, MD, and colleagues at the Jules Bordet Institute in Brussels, Belgium, reported in Prostate Cancer and Prostatic Diseases (2016;19:79-83). The researchers documented complete continence (no pads) and erections sufficient for intercourse in 94% and 80% of patients, respectively.
“Our study suggests that hemiablation HIFU is a valid mini-invasive focal therapy strategy, feasible in day-to-day practice with satisfactory functional outcomes,” the investigators concluded.
The study included patients with localized PCa, a life expectancy of at least 5 years, and a prostate volume less than 40 cm3. The researchers used both multiparametric magnetic resonance imaging (MRI) and MRI-targeted biopsy to localize the tumor.
The cohort had a median follow-up of 39.5 months. The patients had a mean nadir PSA value of 1.6 ng/mL, a 72% reduction compared with initial PSA pre-treatment values. The median time to achieve PSA nadir was 3 months. Biochemical recurrence, according to the Phoenix definition (PSA nadir plus 2 ng/mL) and Stuttgart definition (nadir plus 1.2 ng/mL), occurred in 28% and 36% of patients, respectively.
The 5-year actuarial recurrence-free survival rates for patients with low- and intermediate-risk disease were 75% and 36%, respectively, according to the Phoenix definition and 58% and 27%, respectively, according to the Stuttgart definition.
Three patients showed a residual tumor in the treated lobe, and these were correctly treated with salvage radiation therapy.