Archivos espanoles de urologia · 2025
High-Intensity Focused Ultrasound for Grade Group 1-3 Localized Prostate Cancer: Oncologic and Safety Outcomes in a Taiwanese Cohort.
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Li Chi-Tai, Chen Tien-Mei, Chang Ching-Hsin
Аннотация
BACKGROUND: Prostate cancer commonly affects older men. There is increasing interest in minimally invasive treatment options such as high-intensity focused ultrasound, which provides oncologic control with reduced side effects and functional preservation. We evaluated the oncologic and functional outcomes of whole-gland high-intensity focused ultrasound therapy for localized prostate cancer at a single tertiary center in Taiwan.
METHODS: This retrospective study included 63 patients with primary localized prostate cancer with tumor stage ≤T2 and Grade Group 1-3 who were treated with whole-gland high-intensity focused ultrasound between July 2019 and October 2024. Outcomes included biochemical disease-free survival, prostate-specific antigen kinetics, and complication rates. Biochemical recurrence was defined using the American Society for Therapeutic Radiology and Oncology Phoenix criteria (nadir prostate-specific antigen level + 2 ng/mL). A contemporaneous group of patients that underwent robotic-assisted radical prostatectomy (RaRP) served as control.
RESULTS: The median preoperative prostate-specific antigen level was 8.58 ng/mL. Nadir prostate-specific antigen levels averaged 0.43 ng/mL and were reached after 2.90 months. At a median follow-up of 14.73 months, 20.63% of the patients had experienced disease progression. Higher initial prostate-specific antigen levels, prostate-specific antigen levels at the procedure, and older age were significantly associated with recurrence (p < 0.05). The overall complication rate was 30.16%, without a high Clavien-Dindo grade (4/5). Six patients (9.09%) required high-intensity focused ultrasound twice due to persistent or recurrent disease.
CONCLUSIONS: Whole-gland high-intensity focused ultrasound showed comparable short-term oncological outcomes with an acceptable rate of complications in selected patients with localized prostate cancer. Despite positive preliminary results, the lack of standardized surveillance protocols and the variability in outcome definitions require further prospective randomized studies.
METHODS: This retrospective study included 63 patients with primary localized prostate cancer with tumor stage ≤T2 and Grade Group 1-3 who were treated with whole-gland high-intensity focused ultrasound between July 2019 and October 2024. Outcomes included biochemical disease-free survival, prostate-specific antigen kinetics, and complication rates. Biochemical recurrence was defined using the American Society for Therapeutic Radiology and Oncology Phoenix criteria (nadir prostate-specific antigen level + 2 ng/mL). A contemporaneous group of patients that underwent robotic-assisted radical prostatectomy (RaRP) served as control.
RESULTS: The median preoperative prostate-specific antigen level was 8.58 ng/mL. Nadir prostate-specific antigen levels averaged 0.43 ng/mL and were reached after 2.90 months. At a median follow-up of 14.73 months, 20.63% of the patients had experienced disease progression. Higher initial prostate-specific antigen levels, prostate-specific antigen levels at the procedure, and older age were significantly associated with recurrence (p < 0.05). The overall complication rate was 30.16%, without a high Clavien-Dindo grade (4/5). Six patients (9.09%) required high-intensity focused ultrasound twice due to persistent or recurrent disease.
CONCLUSIONS: Whole-gland high-intensity focused ultrasound showed comparable short-term oncological outcomes with an acceptable rate of complications in selected patients with localized prostate cancer. Despite positive preliminary results, the lack of standardized surveillance protocols and the variability in outcome definitions require further prospective randomized studies.