A new paper by clinical researchers in Korea has concluded that treatment with high-intensity focused ultrasound (HIFU) “does not provide effective oncologic outcomes even in low risk patients with prostate cancer as well as in the intermediate or high risk groups,” but does have a low associated incidence of treatment complications.
The value of HIFU as a first-line treatment for localized prostate cancer has become a highly controversial subject, with some strong advocates and some seriously concerned detractors. The “New” Prostate Cancer InfoLink has tried hard, over the past 4 years, to emphasize the importance of good long-term data in making decisions about the potential of HIFU as a treatment for localized prostate cancer.
The recent paper by Sung et al. reports data from a series of about 126 patients with localized prostate cancer given first-line treatment with HIFU between February 2004 and August 2010 and followed for up to 7 years. We have only seen the abstract of this paper.
The patient data were all reviewed for information on oncologic outcomes and complications. Biochemical recurrence was defined as having occurred in men with a PSA value 1.2 ng/ml higher than the PSA nadir (the so-called Stuttgart criteria), and Kaplan-Meier analyses were carried out to evaluate biochemical recurrence-free and clinical progression-free survival according to risk stratification.
The results reported by Sung et al. are as follows:
- The overall rate of biochemical recurrence was 59.5 percent.
- The median time to biochemical recurrence was 13.8 months.
- The rates of 5-year, biochemical recurrence-free survival were
- 66.3 percent among patients with low-risk disease
- 40.2 percent among patients with intermediate-risk disease
- 21.0 percent among patients with high-risk disease
- The rates of 5-year clinical progression-free survival were
- 73.5 percent among patients with low-risk disease
- 46.0 percent among patients with intermediate-risk disease
- 29.2 percent among patients with high-risk disease
- Risk stratification, PSA nadir, and time to PSA nadir were significant predictors of biochemical recurrence and clinical progression.
- In the first 3 months post-surgery, 11 patients (8.7 percent) had complications.
- No patients required blood transfusions.
- No patients had wound problems, stroke, deep vein thrombosis, or bowel dysfunction.
As indicated above, the authors state clearly their opinion about the lack of effective oncologic outcomes of HIFU and go on to state that, “patients selected to undergo HIFU treatment for prostate cancer must be very carefully chosen. On the other hand, HIFU treatment for prostate cancer had a very low rate of complications.”
The precise type of HIFU equipment used in the treatment of these patients is not stated in the abstract.