Addressing the question of whether high-intensity focused ultrasound (HIFU) for localized prostate cancer is ready for prime time requires a multi-part discussion that considers the whole-gland approach separately from hemiablation/focal HIFU, says Erik P. Castle, MD.
He concluded, however, that there is no justification for recommending either modality when its potential pros and cons are judged relative to those of the appropriate comparator.
Dr. Castle is professor of urology at Mayo Clinic, Phoenix. Discussing the role of HIFU for localized prostate cancer, he said that whole-gland HIFU would be considered as a treatment for patients whose cancer is expected to impact their survival and should be compared against radical prostatectomy. On the other hand, hemiablation/focal HIFU aims to address concern about overtreatment of low-risk prostate cancer and should be considered in relation to active surveillance.
Taking into account data on cancer control and complications, Dr. Castle said that whole-gland HIFU has yet to be proven equal to standard therapies as far as intermediate- and long-term outcomes. He foresaw potential growth of hemiablation/focal HIFU, but concluded that active surveillance is the better option for men with low-risk disease seeking to preserve quality of life.
“There is no free lunch with prostate cancer therapy. Patients pay upfront with continence and potency issues if they choose radical prostatectomy. If they choose whole-gland HIFU, they pay later in life with the possible need for retreatment and other issues, such as stricture,” Dr. Castle explained.
“Whereas hemiablation/focal HIFU might be considered for a patient who is a candidate for active surveillance because he has low-risk disease, determining when these men should be treated is the real target for their care, and I think we are doing a better job with that now than we were a decade ago.”