HIFU results in low morbidity, QoL preservation

Toulouse, France-Another study suggests that hemiablation with high-intensity focused ultrasound (HIFU) is a promising treatment for unilateral localized prostate cancer.

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Study authors found low levels of clinically significant disease after the treatment, and they also reported preservation of quality of life with low levels of morbidity.

“Partial treatment of the gland may fill the gap between active surveillance and radical treatments,” said Pascal Jean Rischmann, MD, PhD, lead author of a study presented at the AUA annual meeting in San Diego.

HIFU remains controversial even in light of its recent FDA approval, as some urologists continue to question its use in localized prostate cancer.

Dr. Rischmann and colleagues designed the study in 2008 amid concerns about existing treatments.

“We had a feeling that radical treatments were of questionable benefit, at least for low and intermediate disease,” said Dr. Rischmann, professor of urology at the Paul Sabatier University and chairman of the department of urology, kidney transplantation, and andrology at the University Hospital of Rangueil in Toulouse, France. But active surveillance posed an underestimation risk.

The prospective study tracked 111 men over 50 years of age (mean age, 64.8±6.2 years) diagnosed with T1c/T2a prostate cancer (mean PSA, 6.2±2.6 ng/mL) who underwent a primary treatment of hemiablation HIFU. They were treated from 2009 to 2014.

The study’s primary outcome was the absence of clinically significant cancer on biopsy (Gleason <7, <2 positive cores, and no cancer core length >3 mm regardless of grade).

Next: 89% free of radical treatment at 2 years

89% free of radical treatment at 2 years

The results: 95% of patients didn’t have clinically significant cancer in the treated lobe, and 67% had no cancer in the prostate gland. At 2 years, 89% were free of radical treatment.

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On average, PSA decreased by 62.9% at 2 years, and the adverse event rate was 12.6% Clavien III.

At 1 year, urinary function was preserved in 97% of patients, and erectile function was preserved in 78.4% (14% had severe erectile dysfunction).

The authors saw no significant decline in quality of life score at 1 year. No patients were lost to follow-up, and two died of other causes, Dr. Rischmann said.

“We had excellent local control,” he said, with an “acceptable” rate of complications.

The study was funded by the French Urological Association. Dr. Rischmann discloses consulting or advising, scientific study or trial, and investment interest for EDAP TMS; consulting or advising for GlaxoSmithKline; and consulting or advising for Olympus.

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