Kevin Shee, MD, outlines factors linked with recurrence after HIFU

High-intensity focused ultrasound (HIFU) has been shown to effectively control prostate cancer with minimal urinary or sexual adverse events, but widespread uptake of the procedure has been hindered by concerns about disease recurrence. To that end, a recent study published in European Urology Focus sought to identify patient factors linked with recurrence and treatment failure in an effort to better characterize optimal patient selection approaches.

In a recent interview with Urology Times®, lead author Kevin Shee, MD, PhD, shared key findings from the analysis. Shee is a PGY-6 chief resident at the University of California, San Francisco (UCSF).

In total, the study included 135 men with prostate cancer who underwent HIFU at UCSF from 2021 to 2023 and had a 1-year post-HIFU MRI-fusion biopsy.

Among all patients, the rates of treatment failure requiring salvage whole-gland treatment or metastasis was 4% at 1 year and 16% overall. The median time to treatment failure was 16 months (IQR, 13 to 18 mo).

Data showed that pre-HIFU grade group 3 or higher disease (HR, 3.11; 95% CI, 1.30 to 7.47) and a high genomic risk score (HR, 2.87; 95% CI, 1.18 to 6.99) were associated with local recurrence. Overall recurrence was also found to be linked with a prostate-specific antigen (PSA) level greater than 10 vs less than 6 ng/ml (HR, 5.64; 95% CI, 1.82 to 17.48).

Notably, urinary and sexual function remained unchanged during the study, which Shee said “highlights the key advantage of this treatment modality.”

There were also no reported instances of Clavien-Dindo grade 2 or higher complications nor cases of urethral stricture or urethra-rectal fistula.

REFERENCE

1. Shee K, Pace WA, Liu AW, et al. Determining optimal patient selection for high-intensity focused ultrasound for prostate cancer. Eur Urol Focus. 2025:S2405-4569(25)00174-9. doi:10.1016/j.euf.2025.06.007