High-Intensity Focused-Ultrasound Focal Therapy Versus Laparoscopic Radical Prostatectomy: A Comparison of Oncological and Functional Outcomes in Low- and Intermediate-Risk Prostate Cancer Patients

Abstract

To compare oncological and functional outcomes of high-intensity focused-ultrasound (HIFU) focal therapy (FT) versus laparoscopic radical prostatectomy (LRP) in patients treated for low- or intermediate-risk prostate cancer (PCa), we retrospectively analyzed data of consecutive patients comprising 30 men, who underwent HIFU-FT, and 96 men who underwent LRP, in an academic center. Oncological outcomes were assessed based on the follow-up prostate-specific antigen values. We used the International Index of Erectile Function short form score to assess erectile function (EF). Urinary continence status was defined based on the number of pads used per day. Median follow-up was 12.5 and 19.1 months in the LRP and HIFU-FT groups, respectively. The effects were computed after propensity score matching and expressed as average treatment effect (ATE). Compared to LRP, HIFU-FT was associated with increased risk of treatment failure (ATE 0.103–0.164, depending on definition, p < 0.01) and lower risk of urinary incontinence (ATE −0.808 at 12 months, p < 0.01). Risk of erectile dysfunction was higher in the LRP group (ATE 5.092, p < 0.01). Our results demonstrate that HIFU-FT may be a reasonable treatment option in selected PCa patients, willing to preserve their EF and urinary continence yet accepting a higher risk of treatment failure.

Win ratio analysis of clinical outcomes of focal therapy and robot-assisted radical prostatectomy for the patients with localized prostate cancer

“…Oncological and functional outcomes have been compared separately in FT and radical prostatectomy [10,11]. Similar oncological outcomes were shown during 8-year follow-up in the report [11].…”

“…If a win/loss decision rule that penalizes these pairs is developed, it may be possible to evaluate the comprehensive treatment e cacy of FT while re ecting patient values. By separating the evaluation of oncological and functional outcomes [10,11], the superiority of functional outcomes of FT and similar oncological outcomes in medium-term follow-up has been reported [23,24]. Considering the characteristics of FT, the clinical outcomes of FT should be evaluated comprehensively using oncological and functional outcomes.…”

“…However, functional outcomes have been evaluated separately from oncological outcomes [10,11]. Because separating these endpoints prevents the evaluation of the e cacy of FT, a comprehensive evaluation method for the clinical outcomes of FT is needed.…”

“…Recently, failure-free survival (FFS), which is the time to biochemical failure, metastasis, or death, has been used for the comparison of oncological outcomes between FT and radical treatment [10,11].…”

Minimally invasive treatment of cirrhotic secondary hypersplenism with high-intensity focused ultrasound

“…Due to its minimally invasive nature, HIFU has attracted much attention in recent years. It has been a mature approach in the treatment of malignant or benign tumors 8 , 9 . Recently, investigators also aimed to use HIFU for the treatment of other diseases, such as secondary hypersplenism.…”