AUA 2018: High Intensity Focused Ultrasound Dose Escalation Leads to Fewer Recurrences in Following Focal HIFU in Prostate Cancer

San Francisco, CA ( Dr. Huber and colleagues evaluated retrospective data to analyze optimal techniques used for high intensity focused ultrasound (HIFU) in prostate cancer. Their database contained 190 men, 131 of whom were treated with 2 HIFU ablation zones, and 59 of whom were treated with 3 ablation zones. This led to 37 matched pairs that were compared with regard to prostate cancer recurrence. The pairs were matched for exact Gleason score and tumor volume as assessed via mpMRI.

In-field treatment failure was defined as any secondary treatment (ADT/chemo, repeat focal ablation or whole gland treatment), prostate cancer metastasis, biopsy-proven >=Gleason 7 without further treatment, and death from prostate cancer.

The 2-zone treatment yielded a 30% recurrence rate at a median of 13 months, while the 3-zone treatment technique yielded a 16% recurrence rate at a median of 11.5 months. There were no other significant outcome differences. The authors’ conclusions are that there are significantly higher in-field treatment recurrences for those patients treated with 2-zones. The idea is that increasing the energy dose with more overlapping zones is likely leading to improved treatment of index lesions.

While this data is interesting, it conforms to our gestalt about ablative therapies. The more focused energy that is used in a cancerous area, the better the treatment of that cancer will be. HIFU is still not widely used in the U.S., and much of our data comes from smaller cohorts in Europe that are pioneering this technology. There is much we still do not know about this technology, but these data should caution us that we must not give up oncological efficacy when using these techniques. A 16% in-field recurrence rate for the higher-energy HIFU technique is still quite high, and we should continue to work to reduce this rate as best as possible.

Presented by: Philipp Huber; Bern, Switzerland

Written by: Shreyas Joshi, MD, Fox Chase Cancer Center, Philadelphia, PA @ssjoshimd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA