High Intensity Focused Ultrasound versus Brachytherapy for the Treatment of Localized Prostate Cancer: A Matched-Pair Analysis

Abstract

Purpose. To evaluate postoperative morbidity and long term oncologic and functional outcomes of high intensity focused ultrasound (HIFU) compared to brachytherapy for the treatment of localized prostate cancer. Material and Methods. Patients treated by brachytherapy were matched 1 : 1 with patients who underwent HIFU. Differences in postoperative complications across the two groups were assessed using Wilcoxon's rank-sum or χ 2 test. Kaplan-Meier curves, log-rank tests, and Cox regression models were constructed to assess differences in survival rates between the two groups. Results. Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p < 0.05). Median oncologic follow-up was 83 months (13–123 months) in the HIFU cohort and 44 months (13–89 months) in the brachytherapy cohort. Median time to achieve PSA nadir was statistically shorter in the HIFU. Biochemical recurrence-free survival rate was significantly higher in the brachytherapy cohort compared to HIFU cohort (68.5% versus 53%, p < 0.05). No statistically significant difference in metastasis-free, cancer specific, and overall survivals was observed between the two groups. Conclusion. HIFU and brachytherapy are safe with no significant difference in cancer specific survival on long term oncologic follow-up. Nonetheless, a randomized controlled trial is needed to confirm these results.

Evaluation of functional outcomes after a second focal high‐intensity focused ultrasonography (HIFU) procedure in men with primary localized, non‐metastatic prostate cancer: results from the HIFU Evaluation and Assessment of Treatment (HEAT) registry

“…Overall these data show a deterioration in urinary and sexual function after a second HIFU treatment. The effect on urinary function is likely to be related to tissue necrosis or thermal injury to the urethra and striated sphincter at the level of the prostatic apex . With this in mind, appropriate margins can mitigate against adverse outcomes .…”

“…The effect on urinary function is likely to be related to tissue necrosis or thermal injury to the urethra and striated sphincter at the level of the prostatic apex . With this in mind, appropriate margins can mitigate against adverse outcomes . Potential causes for erectile dysfunction after focal therapy include thermal effects on the neurovascular bundles .…”

A Systematic Review of Focal Ablative Therapy for Clinically Localised Prostate Cancer in Comparison with Standard Management Options: Limitations of the Available Evidence and Recommendations for Clinical Practice and Further Research

“…Ten SRs were eligible for inclusion [17][18][19][20][21][22][23][24][25][26]. Thirteen comparative studies were excluded, the majority of which included fewer than 50 patients in at least one study arm, or incorporated whole-gland ablative therapy mixed with FT as the index intervention, or used whole-gland ablative therapy as a comparator ( Supplementary Table 1) [27][28][29][30][31][32][33][34][35][36][37][38][39]. In addition, 45 full-text SRs were excluded; the commonest reason for exclusion was inclusion of whole-gland treatment with FT in the analysis (ie, contamination).…”

Magnetic resonance image–guided focused ultrasound robotic system for transrectal prostate cancer therapy

“…Incontinence rates slightly increase after multiple HIFU treatments; 20 however, significant improvements in bladder function are achieved 6 months posttreatment 21 . When compared to brachytherapy, 5‐year cancer‐specific and survival rates do not differ between the two modalities, with HIFU achieving PSA nadir at a shorter time 22 . Cancer specific survival rates after HIFU treatment of 100% and 98% at 5‐year and 8‐year respectively have been noted 23 …”

“…21 When compared to brachytherapy, 5-year cancer-specific and survival rates do not differ between the two modalities, with HIFU achieving PSA nadir at a shorter time. 22 Cancer specific survival rates after HIFU treatment of 100% and 98% at 5-year and 8-year respectively have been noted. 23 The use of MRI as a guidance modality optimises the efficacy of tissue ablation by providing real-time feedback of in situ temperature increase as well as providing higher tissue contrast.…”