We report outcomes of hemigland high intensity focused ultrasound ablation as primary treatment for localized prostate cancer in the United States.
A total of 100 consecutive men underwent hemigland high intensity focused ultrasound (December 2015 to December 2019). Primary end point was treatment failure, defined as Grade Group 2 or greater on followup prostate biopsy, radical treatment, systemic therapy, metastases or prostate cancer specific mortality. IIEF (International Index of Erectile Function), I-PSS (International Prostate Symptom Score) and 90-day complications were reported.
At study entry patients had very low (8%), low (20%), intermediate favorable (50%), intermediate unfavorable (17%) and high (5%) risk prostate cancer. Median followup was 20 months. The 2-year survival free from treatment failure, Grade Group 2 or greater recurrence, repeat focal high intensity focused ultrasound and radical treatment was 73%, 76%, 90% and 91%, respectively. Bilateral prostate cancer at diagnosis was the sole predictor for Grade Group 2 or greater recurrence (p=0.03). Of men who underwent posttreatment biopsy (58), 10 had in-field and 8 out-of-field Grade Group 2 or greater positive biopsy. Continence (zero pad) was maintained in 100% of patients. Median IIEF-5 and I-PSS scores before vs after hemigland high intensity focused ultrasound were 22 vs 21 (p=0.99) and 9 vs 6 (p=0.005), respectively. Minor and major complications occurred in 13% and 0% of patients. No patient had rectal fistula or died.
Short-term results of focal high intensity focused ultrasound indicate safety, excellent potency and continence preservation, and adequate short-term prostate cancer control. Radical treatment was avoided in 91% of men at 2 years. Men with bilateral prostate cancer at diagnosis have increased risk for Grade Group 2 or greater recurrence. To our knowledge, this is the initial and largest United States series of focal high intensity focused ultrasound as primary treatment for prostate cancer.
The Journal of urology. 2020 Sep 08 [Epub]
Andre Luis Abreu, Samuel Peretsman, Atsuko Iwata, Aliasger Shakir, Tsuyoshi Iwata, Jessica Brooks, Alessandro Tafuri, Akbar Ashrafi, Daniel Park, Giovanni E Cacciamani, Masatomo Kaneko, Vinay Duddalwar, Manju Aron, Suzanne Palmer, Inderbir S Gill
USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California., Urology Specialists of the Carolinas, Charlotte, North Carolina., Departments of Radiology Keck School of Medicine, University of Southern California, Los Angeles, California., Departments of Pathology Keck School of Medicine, University of Southern California, Los Angeles, California.