Exploring the Superiority of High-Intensity Focused Ultrasound (HIFU) over Radical Prostatectomy (RP) for Localized Prostate Cancer

Exploring the Superiority of High-Intensity Focused Ultrasound (HIFU) over Radical Prostatectomy (RP) for Localized Prostate Cancer

A recent French trial compared the effectiveness of high-intensity focused ultrasound (HIFU) and radical prostatectomy (RP) as primary treatments for localized prostate cancer. The results of the study, presented by Pascal Rischmann, MD, PhD, at the American Urological Association annual meeting, revealed that HIFU was non-inferior to RP in terms of salvage treatment-free survival, functional outcomes, and overall efficacy.

The HIFI study, a prospective, non-randomized trial conducted across 46 centers in France, included a total of 3,328 patients. Out of these patients, 1,967 received HIFU treatment, while 1,361 underwent RP. Eligible patients had low- or intermediate-risk prostate cancer, with specific criteria related to PSA levels, Gleason scores, clinical stage, and life expectancy. HIFU treatment was delivered using the Focal One device, with a restriction on treating up to 70% of the prostate gland.

At a follow-up of 30 months, patients treated with HIFU had a significantly higher salvage treatment-free survival rate compared to those who underwent RP. The results remained consistent even when adjusted for various baseline covariates, such as age, BMI, PSA level, and grade group. Moreover, patients who received HIFU showed better functional outcomes in terms of urinary continence and erectile function, as reported by Rischmann.

In terms of safety, the study found that complications beyond IIIa were slightly more common in the HIFU group compared to the RP group. However, when it came to functional outcomes, HIFU outperformed RP, particularly in reducing urinary incontinence and erectile dysfunction. The data showed that patients undergoing HIFU had significantly lower rates of these complications, indicating a higher quality of life post-treatment.

The findings of this study suggest that HIFU may be a promising alternative to RP for localized prostate cancer, offering comparable outcomes in terms of survival and superior results in terms of functional outcomes. While further research and trials may be necessary to confirm these results, the initial data is encouraging for the use of HIFU as a primary treatment option for prostate cancer patients.

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