Urologic oncology · 2026
Early oncologic and functional outcomes of partial gland high-intensity focused ultrasound (HIFU) for prostate cancer: First 110 cases at a large U.S. tertiary referral center.
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Lo Eric M, Luu Michael, Das Sanjay, Kim Hyung L, Daskivich Timothy J
Аннотация
INTRODUCTION: High-intensity focused ultrasound (HIFU) is increasingly being used in the United States for primary treatment of localized prostate cancer, but there is limited evidence documenting outcomes during the initial adoption of this technology in the United States. We sought to evaluate cancer control, side effects, and complication rates in the first 110 men who underwent HIFU for localized prostate cancer at our academic tertiary referral center.
METHODS: We retrospectively evaluated the records of men who underwent HIFU as primary treatment for clinically localized prostate cancer at our center from July 2018 to August 2023. Kaplan-Meier analysis was used to calculate failure-free survival (FFS)-defined as freedom from radical treatment, metastases, or death from disease-freedom from repeat HIFU, and in-field clinically significant (Gleason ≥ 3 + 4) recurrence-free survival. Surveillance included prostate-specific antigen (PSA) checks at 3, 6, and 12 months, then every 6 months thereafter, and a multiparametric prostate MRI followed by a biopsy between 6 and 12 months. Urinary incontinence (requirement for pads) and deviation from baseline erectile function were evaluated at 1 year after treatment. The frequency of complications according to the Clavien-Dindo classification system was reported.
RESULTS: A total of 110 patients comprised our final analytic sample, of whom 3%, 56%, 26%, and 15% had low-, favorable intermediate-, unfavorable intermediate-, and high-risk disease, respectively. Most patients underwent focal/hemigland (67%) or subtotal (29%) HIFU. Median follow-up was 17.5 months. FFS (95% CI) was 99% (96%-100%), 97% (93%-100%), and 92% (84%-100%) at 12, 18, and 24 months, respectively. Freedom from repeat HIFU (95% CI) was 90% (84%-97%), 86% (78%-95%), and 84% (74%-94%) at 12, 18, and 24 months, respectively. In-field clinically significant recurrence-free survival (95% CI) was 88% (81%-95%), 81% (73%-91%), and 79% (69%-90%) at 12, 18, and 24 months, respectively. A total of 14 patients developed a urethral stricture following HIFU. Urethral stricture rates were lower in the focal and hemigland ablation groups (5.8%) compared to the subtotal (18.9%) and whole gland (75%). Of the 69 men with 1-year follow-up, 66 (95.7%) were continent with zero pad requirement, and 61 (88.4%) maintained baseline pre-operative erectile function.
CONCLUSIONS: Our initial experience with partial gland HIFU for patients with select localized prostate cancers shows low rates of treatment escalation, modest rates of in-field recurrence and retreatment, and low morbidity.
METHODS: We retrospectively evaluated the records of men who underwent HIFU as primary treatment for clinically localized prostate cancer at our center from July 2018 to August 2023. Kaplan-Meier analysis was used to calculate failure-free survival (FFS)-defined as freedom from radical treatment, metastases, or death from disease-freedom from repeat HIFU, and in-field clinically significant (Gleason ≥ 3 + 4) recurrence-free survival. Surveillance included prostate-specific antigen (PSA) checks at 3, 6, and 12 months, then every 6 months thereafter, and a multiparametric prostate MRI followed by a biopsy between 6 and 12 months. Urinary incontinence (requirement for pads) and deviation from baseline erectile function were evaluated at 1 year after treatment. The frequency of complications according to the Clavien-Dindo classification system was reported.
RESULTS: A total of 110 patients comprised our final analytic sample, of whom 3%, 56%, 26%, and 15% had low-, favorable intermediate-, unfavorable intermediate-, and high-risk disease, respectively. Most patients underwent focal/hemigland (67%) or subtotal (29%) HIFU. Median follow-up was 17.5 months. FFS (95% CI) was 99% (96%-100%), 97% (93%-100%), and 92% (84%-100%) at 12, 18, and 24 months, respectively. Freedom from repeat HIFU (95% CI) was 90% (84%-97%), 86% (78%-95%), and 84% (74%-94%) at 12, 18, and 24 months, respectively. In-field clinically significant recurrence-free survival (95% CI) was 88% (81%-95%), 81% (73%-91%), and 79% (69%-90%) at 12, 18, and 24 months, respectively. A total of 14 patients developed a urethral stricture following HIFU. Urethral stricture rates were lower in the focal and hemigland ablation groups (5.8%) compared to the subtotal (18.9%) and whole gland (75%). Of the 69 men with 1-year follow-up, 66 (95.7%) were continent with zero pad requirement, and 61 (88.4%) maintained baseline pre-operative erectile function.
CONCLUSIONS: Our initial experience with partial gland HIFU for patients with select localized prostate cancers shows low rates of treatment escalation, modest rates of in-field recurrence and retreatment, and low morbidity.