In 2013 and 2014, three clinical studies (1;2;3) from French and German centers published long-term results (10 years) of total HIFU treatment and validated its efficacy: according to cancer risk, specific survival rate at 10 years is between 92% and 99%; survival rate without metastasis at 10 years is between 86% and 100%.
In november 2016, results of the multicenter study (4) conducted by the French Association of Urology (AFU) on focal treatment (ablation of the infected prostate lobe only) of prostate cancer were published in the European Urology journal. This study showed an absence of clinically significant cancer in the treated lobe in 95% of cases and an optimal preservation of the continence for 97% of the patients and of the erectile function for more than 78% of them.
Continence and sexual function preservation
Multicenter study (4) conducted by the French Association of Urology (AFU) showed optimal preservation of continence for 97% of patients and erectile function for more than 78% of them. In another study carried out by a medical team from Institut Bordet in Brussels (5), 80% of patients retained their sexual function, while more than 94% maintained perfect continence.
HIFU prostate cancer treatment efficiency for recurrenceafter radiation therapy
Dr. Albert Gelet from urology department of Edouard Herriot Hospital in Lyon, was the pioneer in the treatment of local recurrences after radiotherapy with HIFU treatment. An article from Edouard Herriot Hospital medical team has been published in the “Radiotherapy and Oncology” 2012 (6) journal describing a series of 290 patients treated with this indication. Results are very satisfactory with 81% of the control biopsies negative for an acceptable morbidity in this population at risk which is offered a new therapeutic chance.
Main side effects of HIFU treatment (total or sub-total gland) are presented below (1-5).
We mainly observe : narrowing of the prostatic urethra (stenosis) that may occur in the months following treatment. An endoscopic procedure (resection, urethrotomy) may be necessary to restore the normal permeability of of the urethra closed by fibrosis.
Patients with persistent urinary stress incontinence (1 to 3%) may receive a specific treatment.
The results from HIFU focal treatment of prostate cancer, particularly those of the multicenter hemi-ablation study, revealed excellent preservation of quality of life with minimal impact on urinary and sexual function (97% of incontinence, 78% preservation of erectile function) .
Main side effects of total HIFU treatment :
- Urinary incontinence, above one change per day (inability to control urine flow ): 1,5 à 3,1 % of patients
- Temporary urinary retention (inability to drain urine): 0 – 9 % of patients
- Preservation of sexual potency (for sexually active patients before HIFU treatment): 42,3 – 85 % of patients (1)
(1) Crouzet, S., et al., Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. Eur Urol, 2014. 65(5): p. 907-14.
(2) Thuroff, S. and C. Chaussy, Evolution and outcomes of 3 MHz high intensity focused ultrasound therapy for localized prostate cancer during 15 years. J Urol, 2013. 190(2): p. 702-10.
(3) Ganzer R, Fritsche HM, Brandtner A, Bründl J, Koch D, Wieland WF, et al. Fourteen-year oncological and functional outcomes of high-intensity focused ultrasound in localized prostate cancer.
(4) Rischmann P, Gelet A, Riche B, Villers A, Pasticier G, Bondil P, et al. Focal High Intensity Focused Ultrasound of Unilateral Localized Prostate Cancer: A Prospective Multicentric Hemiablation Study of 111 Patients. Eur Urol.2017;71(2):267-73.
(5) Albisinni S, Aoun F, Bellucci S, Biaou l, Limani K, Hawaux E, Peltier A, Van Velthoven R. Comparing HIFU Hemi ablation to Radical Prostatectomy in the Management of Unilateral Prostate Cancer: a matched pair analysis. J Endourol. 2016 Oct 31
(6) Crouzet S. et al. Locally recurrent prostate cancer after initial radiation therapy: Early salvage high-intensity focused ultrasound improves oncologic outcomes. Radiotherapy and Oncology 2012;Nov;105(2):198-202