An unenthusiastic review of HIFU in prostate cancer


The potential value of high-intensity focused ultrasound (HIFU) as a treatment for prostate cancer continues to foment controversy between its advocates and its detractors. A couple of weeks ago we commented on a review by Warmuth et al. (a group of European authors). Now there is another review from a group of Canadian authors.

In their new review, Lukka et al. make the following points:

  • They could identify no published data about HIFU based on randomized, controlled trials or meta-analyses.
  • They were able to find just two clinical practice guidelines — but neither contained reference to any randomized, controlled trials.
  • They identified articles reporting on 34 clinical case series of HIFU treatment.
    • 29/34 evaluated HIFU as primary treatment.
    • 5/34 evaluated HIFU as salvage treatment for recurrence after radiotherapy.
  • The outcomes most commonly used to determine efficacy were post-treatment biopsy rates and PSA levels.
  • Among the 29 studies of HIFU as a primary treatment
    • Negative biopsy rates ranged from 35 to 95 percent in 21 studies.
    • A PSA nadir of ≤ 0.5 ng/ml was observed in 55 to 91 percent of patients in 10 studies.
    • Mean PSA nadirs of between 0 and 1.9 ng/ml were observed in 17 studies.
    • 5 studies reported 5-year disease-free survival rates ranging from 55 to 95 percent.
  • Among the 5 studies of HIFU as a salvage treatment
    • Negative biopsy rates ranged from 73 to 84 percent in 4 studies
    • A PSA nadir of ≤ 0.5 ng/ml was observed in 57 to 66 percent of patients in 3 studies.
    • Mean PSA nadirs of between 1.97 and 2.38 ng/ml were observed in 2 studies, respectively.

The reviewers conclude that, “Current evidence on HIFU use in prostate cancer patients is of low quality, rendering it difficult to draw conclusions about its efficacy,” and that the widespread use of HIFU is not supported by such current evidence.

The “New” Prostate Cancer InfoLink continues to stand by the comments about HIFU’s future potential that we made in discussing the review by Warmuth et al. a couple of weeks ago. However, the comparative lack of really good, large studies from respected clinical centers is not helping people to evaluate the potential of HIFU in a timely manner.

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