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Effectiveness of HIFU

Focal AblationEfficacité médicale

The team lead by professor Guy Vallancien (IMM Paris) recently won an award for the best study1 for its pioneering research in an ablatherm-based "disease control" approach. From 1997 to 2000, 12 patients received "focal treatment" with HIFU. Ten years on, none of the patients have died from prostate cancer. No significant side effects or metastases have been reported. During the follow-up period, five patients received additional treatment but there was no increase in complications. In a more recent multi-centric study independently promoted by the French Association of Urology (AFU) and published in the prestigious European Urology Journal,2 the focal treatment with HIFU (hemiablation) has shown an efficient cancer control at 2 years with no clinically significant cancer in the treated lobe for 95% of the patients, an optimal preservation of the quality of life with 97% continence, and 78% potency preservation.

Long-term efficiency

A multicenter study conducted between 1995 and 2000, involving 402 patients at six European sites, revealed that the cancerous tissue disappeared in 87% of patients who received first-line treatment with HIFU. A recently-published scientific paper,2 which also concerns several European centers, confirmed the long-term effectiveness of HIFU (with some patients having nine-year follow-up histories).

(2) First Analysis of the Long-Term Results with Transrectal HIFU in Patients with Localised Prostate Cancer, Andreas Blana et al, European Urology 53 (2008) 1194-1203

Continence and sexual function preservation

98% of patients did not experience any incontinence issues3 and 87% remained sexually potent when ablathermy was performed in conjunction with a strategy to preserve the erector nerves.4

(3) The Status of High-Intensity Focused Ultrasound in the Treatment of Localized Prostate Cancer and the Impact of a Combined Resection, C. Chaussy, S. Thüroff, Munich-Harlaching University, Germany, Current Urology Reports, Volume 4, Issue 3, 2003: 248

(4) High-Intensity Focused Ultrasound and Localized Prostate Cancer: Efficacy Results from the European Multicentric Study, S. Thüroff et al, Journal of Endourology, Volume 17, Number 8, October 2003

Effective cancer control

According to an international literature review by Association Française d’Urologie5 concerning the effectiveness of and tolerance to HIFU in patients with localized prostate cancer who received first-line treatment with the HIFU device, up to 93% (64-93%) of patients met the criteria for being declared cured.

Another leading European HIFU center, the Saint Joseph Caritas hospital in Germany has published a paper entitled Eight Years’ Experience With High-Intensity Focused Ultrasonography for Treatment of Localized Prostate Cancer,6 covering a cohort of 163 patients. After an average follow-up of almost five years, 92.7% of patients had negative check-up biopsies. More than 98% of patients reported no severe incontinence. The ability to have erections depended on the treatment strategy chosen by the patient and his urologist.

(5) High-intensity focused ultrasound in prostate cancer; a systematic literature review of the French Association of Urology, Xavier Rebillard et al, BJU International 2008 1464-410X.2008.07504.x

(6) Eight Years’ Experience With High-Intensity Focused Ultrasonography for Treatment of Localized Prostate Cancer, Andreas Blana et al, Journal of Urology 2008.06.062

Robotic HIFU prostate tissue ablation is efficient for recurrence after radiation therapy

Doctors Albert Gelet and F.J. Murat from the urology department at Edouard Herriot Hospital in Lyons pioneered the treatment of cases of localized recurrence following radiotherapy.7 A paper by Doctors Murat and Poissonnier published in European Urology 2008) describes a cohort of 167 patients treated for the aforementioned indication. The results after a 10-year follow-up are highly satisfactory: 73% of check-up biopsies were negative and the morbidity rate remained acceptable among a high-risk population offered a new chance of a cure.

(7) Mid-term Results Demonstrate Salvage High-Intensity Focused Ultrasound (HIFU) as an Effective and Acceptably Morbid Salvage Treatment Option for Locally Radiorecurrent Prostate Cancer, François-Joseph Murat et al, 2008 European Urology, doi:10.1016/j.eururo.2008.04.091

Side effects

Based on the experience gained and published in the literature since 2000 and as with any treatment of prostate cancer, HIFU treatment may have some undesirable effects. Beyond the risks of incontinence and erectile dysfunction mentioned above, a narrowing of the urethra and the bladder neck can occur following a focused ultrasound treatment.

 

  1. Whole-gland Ablation of Localized Prostate Cancer with High-Intensity Focused Ultrasound: Oncologic Outcomes and Morbidity in 1002 Patients. Crouzet S. et al. European Urology 2014 May;65(5):907-14

  2. Evolution and outcomes of 3 MHz high intensity focused ultrasound therapy for localized prostate cancer during 15 years. Thüroff S. et al. J Urol. 2013 Aug;190(2):702-10

  3. Ganzer, R., Fritsche, H.-M., Brandtner, A., Bründl, J., Koch, D., Wieland, W. F. and Blana, A. (2013), Fourteen-year oncological and functional outcomes of high-intensity focused ultrasound in localized prostate cancer. BJU Int, 112: 322–329. doi:10.1111/j.1464-410X.2012.11715.x;

  4. Focal High Intensity Focused Ultrasound of Unilateral Localized Prostate cancer: A Prospective Multicentric Hemiablation Study of 111 Patients. Rischmann P. et al, European Urology 2017 February;71(2):267-273

  5. Comparing High-Intensity Focal Ultrasound Hemiablation to Robotic Radical Prostatectomy in the Management of Unilateral Prostate Cancer: A Matched-Pair Analysis, Albisinni S. et al. Journal of Endourology 2017 January;31(1):14-19;

  6. Locally recurrent prostate cancer after initial radiation therapy: Early salvage high-intensity focused ultrasound improves oncologic outcomes Crouzet S. et al., 2012 Radiotherapy and Oncology 2012 Nov;105(2):198-202.

 

Last update 14 February 2017. 

  • Glossary
  • Bladder
    Organ in which urine accumulates before being expelled from the body.
  • Erector nerve
    These nerves, situated along the perimeter of the prostate, initiate penile erections.
  • High Intensity Focused Ultrasound (HIFU)
    Medical technique that treats tumors by using focused ultrasound pulses to generate heat.
  • Incontinence
    Inability to refrain from urinating or defecating.
  • Prostate
    Gland in the male genital system that plays a role in semen production.
  • Radical prostatectomy
    Surgical procedure that completely removes the prostate.
  • Recurrence
    Reappearance of signs indicating the presence of cancer following a period of remission.
  • Side effect
    Generally adverse secondary consequence of a treatment.
  • Ultrasound
    Painless medical imaging examination performed using an ultrasound scanner.
  • Urethra
    Tube leading from the bladder through which urine leaves the body. The urethra also carries semen during an ejaculation.
  • Urologist
    Physician who specializes in urinary and genital conditions.
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