Eur Urol Focus: How do tissue changes relate to treatment outcomes during the treatment of prostate cancer with high-intensity focused ultrasound lesions?

Tissue retention strategies have been increasingly used in the treatment
of localized prostate cancer.
Ultrasound-guided high-intensity focused ultrasound (HIFU) lesion ablation has good short- and medium-term oncological effects
.
Advances in HIFU treatment, such as the introduction of tissue change monitoring (TCM), can further improve treatment outcomes
.

Recently, researchers from the United States published an article in Eur Urol Focus to evaluate the relationship between intraoperative TCM and oncological outcomes after 12 months during focused HIFU therapy for localized prostate cancer.

The study population consisted of 70 consecutive male patients with prostate cancer in a single institution, excluding patients with prior treatment, metastasis, or pelvic radiation, and eventually 55 male patients were included in the final cohort
.
All patients were treated with HIFU lesions and a magnetic resonance (MR) fusion biopsy
was performed 12 months later.
Tissue changes
are quantified intraoperatively by measuring the backscatter of ultrasonic waves during ablation.
The primary results were Gleason grade group (GG) ≥ grade 2 cancers
biopsied after ablation.
Secondary outcomes included cancer with GG≥1, prostate imaging reporting and data system (PI-RADS) score ≥3, and evidence of
tissue destruction by magnetic resonance imaging (MRI) after treatment.
A t-test analysis was performed to evaluate the mean TCM score and ablation efficacy
.
Multivariate logistic regression assessed the chance
of residual cancer for each increase in the TCM score.

It was found that a lower mean TCM score (0.
70 vs 0.
97, P=0.
02) in the tumor area was associated with
persistent GG≥2 cancer after HIFU treatment.
After adjusting for initial prostate-specific antigen, PI-RADS score, Gleason GG, positive core, and age, each increase in TCM reduced the chance of residual GG≥2 carcinoma on biopsy after ablation by 89% (odds ratio: 0.
11, confidence interval, CI: 0.
01-0.
97).

At the time of treatment, men with a higher mean TCM score (0.
99 vs 0.
72, p=0.
02) were less likely to develop abnormal MRI (PI-RADS≥3) within 12 months of surgery
.
Cases with high TCM scores also saw greater tissue destruction measured on MRI and fewer
lesions visible on MRI after ablation.

Oncology outcomes with high TCM scores versus low TCM scores

In summary, tissue changes measured using TCM values during treatment with focal HIFU in the prostate were associated with histopathological and radiological outcomes 12 months
postoperatively.

Original source:

Yash S Khandwala， Simon John Christoph Soerensen， Shravan Morisetty et al.
The Association of Tissue Change and Treatment Success During High-intensity Focused Ultrasound Focal Therapy for Prostate Cancer.
Eur Urol Focus.
Nov 2022