Frontiers in urology · 2026
Comparative outcomes of focal HIFU versus active surveillance in low- and intermediate-risk localized prostate cancer: a 75-month retrospective cohort study.
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Jaabou Mohammad, Buscarini Maurizio, Zaytoun Osama, Dovey Zachary, Hildebrand Brooke, Awan Modassar, Bada Maida, Al Ogaili Mohammad, Rabie Ahmad
Аннотация
OBJECTIVE: Focal high-intensity focused ultrasound (HIFU) is a minimally invasive treatment for localized prostate cancer. Its comparative effectiveness against active surveillance (AS) remains underexplored in patients eligible for either strategy.
METHODS: This retrospective cohort study analyzed 635 men with localized prostate cancer treated between 2018 and 2023: 303 received focal HIFU and 332 underwent AS. Only low-risk and favorable intermediate-risk patients per NCCN guidelines were included (PSA <20 ng/mL, stage ≤T2b, ISUP ≤2, <50% positive cores). Multiparametric MRI and targeted biopsies confirmed eligibility. Outcomes included progression to clinically significant prostate cancer (csPC: ISUP ≥3 or ISUP 2 with PIRADS ≥4), radical treatment-free survival, PSA kinetics, and functional outcomes (IPSS, IIEF-5, continence).
RESULTS: Baseline characteristics were comparable. At 12 months, csPC-free survival was higher with HIFU in intermediate-risk patients (95.8% vs. 84.0%, p=0.0018) and low-risk patients (97.6% vs. 88.3%, p=0.0035). At a median follow-up of 75 months, HIFU maintained superior csPC-free rates in both risk groups. Radical treatment-free survival was similar in both low and intermediate risk group 76% vs 77.1% and 83.2% vs 80.3% respectively, time to radical treatment was significantly longer in the HIFU group. PSA reductions at 3 and 6 months were greater with HIFU. Functional outcomes, including erectile function, continence, and urinary symptoms, were comparable between groups.
CONCLUSIONS: Focal HIFU offers better short-term oncological control and delays the need for radical treatment compared to AS, with similar preservation of urinary and sexual function. These results support its use in selected patients seeking a balance between cancer control and quality of life.
METHODS: This retrospective cohort study analyzed 635 men with localized prostate cancer treated between 2018 and 2023: 303 received focal HIFU and 332 underwent AS. Only low-risk and favorable intermediate-risk patients per NCCN guidelines were included (PSA <20 ng/mL, stage ≤T2b, ISUP ≤2, <50% positive cores). Multiparametric MRI and targeted biopsies confirmed eligibility. Outcomes included progression to clinically significant prostate cancer (csPC: ISUP ≥3 or ISUP 2 with PIRADS ≥4), radical treatment-free survival, PSA kinetics, and functional outcomes (IPSS, IIEF-5, continence).
RESULTS: Baseline characteristics were comparable. At 12 months, csPC-free survival was higher with HIFU in intermediate-risk patients (95.8% vs. 84.0%, p=0.0018) and low-risk patients (97.6% vs. 88.3%, p=0.0035). At a median follow-up of 75 months, HIFU maintained superior csPC-free rates in both risk groups. Radical treatment-free survival was similar in both low and intermediate risk group 76% vs 77.1% and 83.2% vs 80.3% respectively, time to radical treatment was significantly longer in the HIFU group. PSA reductions at 3 and 6 months were greater with HIFU. Functional outcomes, including erectile function, continence, and urinary symptoms, were comparable between groups.
CONCLUSIONS: Focal HIFU offers better short-term oncological control and delays the need for radical treatment compared to AS, with similar preservation of urinary and sexual function. These results support its use in selected patients seeking a balance between cancer control and quality of life.