Focal therapy for prostate cancer (PCa) remains experimental. Aim of the current study is to review available evidence and perform a pooled analysis exploring oncologic and functional results of High Intensity Focal Ultrasound (HIFU) focal therapy for the treatment of unilateral PCa.
The National Library of Medicine Database was searched for relevant articles. A wide search was performed including the combination of following words: "HIFU", "prostate", "cancer", "focal". Overall, 167 articles were reviewed. Of these, 7 articles were identified and eligible for the pooled analysis. Data on HIFU hemiablation or focal prostate ablation oncologic and functional results were pooled from these 7 studies that included 366 men with unilateral PCa.
In the 366 analyzed cases, mean age was 67 years (95%CI 66-69), and mean pre-operative PSA was 6.4ng/ml (5.5 - 7.4). 3 studies included PCa up to Gleason 7 (3+4), 3 studies did include also Gleason 7(4+3), while one study had no limitation in terms of Gleason score. Regarding early complications, low grade Clavien-Dindo I-II were reported in 26 % (16-37), while high-grade Clavien-Dindo ≥III were found in 3.8% (0-8.6). Analyzing oncologic outcomes, mean follow-up was 26 months (23-31): at one year after HIFU, negative biopsy rate for clinically significant PCa was 87% (79-96), whilst salvage treatment free survival rate was 92% (85-98) (Fig 1). Regarding functional outcomes, reported potency rates were 74% (64-84), and continence 96% (91-100), although definitions of potency and continence were not homogenous across studies.
This pooled analysis of the results of focal HIFU treatment of prostate cancer shows promising oncologic and functional outcomes. Well select patients may be candidates for such a conservative partial treatment of the gland. Well designed trials are awaited to compare HIFU focal treatment to current standard of care.
Journal of endourology. 2018 May 23 [Epub ahead of print]
Simone Albisinni, Christian Melot, Fouad Aoun, Ksenija Limani, Alexandre Peltier, Pascal Rischmann, Roland van Velthoven
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Go Beyond the Abstract and Read a Commentary by Fouad Aoun, MD, MSc, FEBU, department of Urology, Jules Bordet Institute, Brussels, Belgium