Eur Urol Focus: Interim oncological efficacy and patient-reported outcomes after local high-intensity focused ultrasound therapy for prostate cancer

Multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound (TRUS) fusion guided high-intensity focused ultrasound (HIFU) therapy is a local treatment
for local prostate cancer (PCa) seen by MRI.
High-quality evidence on its clinical efficacy remains limited
.

Recently, researchers from Germany published an article in the journal Eur Urol Focus investigating the medium-term oncology efficacy and patient-reported outcomes (PROMs)
of HIFU.

Studies were designed as prospective single-center cohort studies conducted from 2014 to 2020
.
The study included patients with an MRI/TRUS fusion and systemic prostate biopsy, ISUP grading (GG) ≤2, and a prostate-specific antigen (PSA) < of 10 ng/ml
.
The intervention studied was local HIFU therapy guided by MRI/TRUS fusion
.
The primary outcome of the study was the cancer-free rate
of lesion biopsy after 1 year of HIFU treatment.
Secondary endpoints included survival without treatment (STFS), survival without metastasis (MFS), overall survival (OS), and PROMs
recommended by the International Federation for Health Outcome Measurement.

A total of 50 patients (median [range] age 68 [48 to 80] years; median PSA 6.
5 [1.
2-9.
9] ng/ml; GG1：54% [n=27]，GG2：46% [n=23]）
。 From baseline to month 12, the median (range) decline in PSA was 51% (35.
9-72.
7%)
.
Overall, 37/50 patients (74%) received biopsies
after 1 year.
23 patients (46%; GG1：20% [n=10]； GG >1：26% [n = 13]； infield 40% [n = 20]) discovered PCa
.
At a median follow-up of 42 (13-73) months, PCa
was detected in 30 men (60%).
Of all patients, 19 (38%) received salvage therapy (median [95% confidence interval] STFS 53 [44.
3 to 61.
7] months).

MFS and OS are 100% and 98%,
respectively.
The extended EPCI-26 sexual function score decreased by 20.
8 points (P=0.
372).

Imaging and biopsy results after 1 year of HIFU treatment

In summary, after 1 year of MRI/TRUS-guided local HIFU therapy, only half of the treated patients can completely ablate the tumor, and there will be recurrence at medium-term follow-up, and some patients have decreased
efficacy.

Original source:

Niklas Westhoff ， Ramona Ernst， Karl-Friedrich Kowalewski et al.
Medium-term Oncological Efficacy and Patient-reported Outcomes After Focal High-intensity Focused Ultrasound： The FOXPRO Trial.
Eur Urol Focus.
Nov 2022