Focal High Intensity Focused Ultrasound Effective for Treating Prostate Cancer

Short-term results of focal high intensity focused ultrasound (HIFU) ablation of the prostate suggest safety, excellent potency, and continence preservation as well as adequate short-term prostate cancer control in patients with localized prostate cancer, according to a study published in The Journal of Urology.

Focal HIFU ablation is an outpatient procedure that uses a focused ultrasound beam to raise the temperature inside the prostate to approximately 194 degrees Fahrenheit to destroy targeted areas of prostate tissue. The procedure takes approximately 2 hours and the patients are often discharged home the same day.

“This positive data empowers urologists to use focal HIFU ablation to effectively address prostate cancer without the intrinsic side effects of radical treatments,” first author Andre Abreu, MD, urologic surgeon with Keck Medicine and assistant professor of clinical urology and radiology at the Keck School of Medicine of USC, said in a press release. “We hope this study encourages prostate cancer patients to talk to their doctor about all potential treatment options to ensure that they receive a personalized care plan that addresses their individual needs.”

In this study, researchers evaluated 100 consecutive men in the US who underwent a HIFU procedure from December 2015 to December 2019. IIEF (International Index of Erectile Function), I-PSS (International Prostate Symptom Score), and 90-day complications were all reported.

At study entry, patients were grouped by prostate cancer risk, including very low (8%), low (20%), intermediate favorable (50%), intermediate unfavorable (17%) and high (5%) risk prostate cancer. Median follow-up was 20 months. The primary end point was treatment failure.

During follow-up, 91% of patients who underwent HIFU successfully avoided radical treatment. Further, 73% of patients did not experience treatment failure, which was defined as clinically significant cancer recurrence, metastases or mortality, or the need for additional hormone therapy, chemotherapy, surgery, or radiation.

Of note, bilateral prostate cancer at diagnosis was the exclusive predictor for grade group 2 or greater recurrence (P = .03). Of 58 men who underwent posttreatment biopsy, 10 had in-field and 8 had out-of-field grade group 2 or greater positive biopsy. Moreover, continence, defined as needing no pad, was maintained in 100% of patients. Median IIEF-5 and I-PSS scores before versus after hemigland HIFU were 22 versus 21 (P = .99) and 9 versus 6 (P = .005), respectively.

Importantly, minor and major complications were observed in 13% and 0% of patients. Minor complications, including difficulties with urination and urinary tract infection, were also addressed without major interventions. In addition, no patient had rectal fistula or died.

Ultimately, study participants were typically discharged the same day as their procedure and resumed regular activities shortly thereafter.

Notably, HIFU ablation has been used by urologists worldwide to treat patients with prostate cancer for many years. However, this technology was only approved by the FDA for prostate tissue ablation in 2015.

References:

1. Abreu AL, Peretsman S, Iwata A, et al. High Intensity Focused Ultrasound Hemigland Ablation for Prostate Cancer: Initial Outcomes of a United States Series. The Journal of Urology. doi: 10.1097/JU.0000000000001126

2. Innovative, minimally invasive treatment can help maintain prostate cancer patients’ quality of life [news release]. Keck Medicine of USC. Published September 8, 2020. Accessed September 9, 2020. https://news.keckmedicine.org/hifu-can-help-maintain-prostate-cancer-patients-quality-of-life/