Survival and quality of life outcomes of high-intensity focused ultrasound treatment of localized prostate cancer

Abstract

Background: To evaluate the survival and quality of life (QoL) outcomes of high-intensity focused ultrasound (HIFU) whole-gland ablation for localized prostate cancer. Methods: Over 8 years, men with localized prostate cancer treated with whole-gland HIFU were prospectively followed. Transrectal prostate ablation was performed under general anesthesia with Sonablate-500 ® (Sonacare Medical©, Charlotte, North Carolina, USA). The primary outcome was failure-free survival defined as no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancerespecific mortality. Secondary outcomes included both survival outcomes and QoL measures. Results: Of 70 men, 29.7% had International Society of Urological Pathology (ISUP) grade 1, 43.8% ISUP 2, 10.9% ISUP 3, and 15.6% ISUP 4 disease. At median follow-up of 83.4 months, overall mortality was 8.6% and prostate cancerespecific mortality 0%. Failure-free survival was 78.2% at 5 years and 71.2% at 7 years. Of all men, 7.1% of men developed metastases, with median metastasis-free survival of 75.4 months. There was negligible post-HIFU urinary incontinence or lower urinary tract symptom with a median Male Urogenital Distress Inventory score of 32 at 6 months and 33 at 12 months and median IPSS of 4 at 6 months and 3 at 12 months. Median Radiation Therapy Oncology Group rectal toxicity score was 0 throughout. In men who had mild or no erectile dysfunction at baseline (International Index of Erectile Function !17), the mean International Index of Erectile Function score declined to 37% from 23.5 at baseline to 14.7 at 12 months. Conclusion: At median follow-up of 7 years, whole-gland HIFU appears to have comparable survival outcomes with other cohort studies involving radical prostatectomy and radiotherapy patient. It has low impact on QoL, preserved urinary continence, and erectile function approximate to nerve-sparing prostatectomy. Whole-gland HIFU presents a potential alternative minimally invasive and safe option for the treatment of localized prostate cancer.

Evaluation of post-ablation mpMRI as a predictor of residual prostate cancer after focal high intensity focused ultrasound (HIFU) ablation

“…IPSS scores in our study were also not different after treatment. This is consistent with other HIFU studies that report a <1 point change from mean baseline IPSS up to 12 months after treatment [ 25 , 29 , 30 ].…”

3D synthetic aperture imaging with a therapeutic spherical random phased array for transcostal applications

“…High-intensity focused ultrasound (HIFU) has been successfully used for non-invasive surgery in the treatment of a wide variety of lesions, including liver, kidney and prostate tumors (Illing et al 2005, Roberts et al 2006, Murat et al 2009, Aubry et al 2013, Holbrook et al 2014, Lee et al 2019, Royce et al 2020. Phased arrays have advantages over single-element spherically-curved transducers for HIFU due to their ability to electronically steer the HIFU beam without any mechanical movement (Ebbini and Cain 1989, Gavrilov and Hand 2000, Hynynen et al 2004, Rosnitskiy et al 2018, Zubair and Dickinson 2019.…”

Focal Therapy for Prostate Cancer: Complications and Their Treatment

“…Incontinence was mostly related to urgency and usually occurred in the initial period after catheter withdrawal. Multiple prospective studies confirm low incontinence rates ( 12 , 27 , 35 ) with pad-free continence rates ranging between 95 and 100%. Patients presenting urinary incontinence after focal therapy rarely require more than one pad a day, thus social continence is maintained in most cases ( 27 ) as reported with focal HIFU.…”