Disclosures: Abreu and Valerio report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
November 04, 2020
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High-intensity focused ultrasound ablation safe, effective in prostate cancer

Disclosures: Abreu and Valerio report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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High-intensity focused ultrasound partial gland ablation appeared safe and led to improvements in short-term prostate cancer control among men with localized disease, according to results of a study published in The Journal of Urology.

The noninvasive strategy enabled 91% of men to avoid radical treatment at 2 years, researchers noted.

High-intensity focused ultrasound partial gland ablation led to improvements in short-term prostate cancer control among men with localized disease.
High-intensity focused ultrasound partial gland ablation led to improvements in short-term prostate cancer control among men with localized disease.

“Partial gland ablation for prostate cancer emerged as an organ-sparing concept with the benefits of low morbidity and maintained quality of life regarding potency and continence using minimally or noninvasive techniques and technologies,” Andre L. Abreu, MD, assistant professor of clinical urology and director of image-guided surgery and focal therapy of prostate cancer at Keck School of Medicine of USC, told Healio. “Whole or partial gland high-intensity focused ultrasound ablation for prostate cancer has been performed in several countries for more than 20 years.”

The FDA cleared high-intensity focused ultrasound for prostatic tissue ablation in 2015.

Andre L. Abreu, MD
Andre L. Abreu

“Since then, the procedure has been applied for prostate cancer ablation,” Abreu said. “However, reports of high-intensity focused ultrasound partial gland ablation performed in the U.S. are sparse. To our knowledge, we report the initial and largest U.S. series of high-intensity focused ultrasound partial gland ablation as first-line treatment for prostate cancer.”

Abreu and colleagues analyzed 100 men (median age, 65 years; median PSA density, 0.16 ng/mL/cc; median prostate volume, 34 cc) who underwent hemigland high-intensity focused ultrasound between December 2015 and December 2019.

Treatment failure — defined as grade group 2 or higher on follow-up prostate biopsy, radical treatment, systemic therapy, metastases or prostate cancer-specific mortality — served as the study’s primary endpoint. Researchers additionally reported International Index of Erectile Function (IIEF) scores, International Prostate Symptom Scores (I-PSS) and 90-day complication rates.

At baseline, most men (50%) had intermediate-favorable risk for prostate cancer, followed by 20% at low risk, 17% at intermediate-unfavorable risk, 8% at very low risk and 5% at high risk.

Median follow-up was 20 months.

At 2-year follow-up, 73% of men had not experienced treatment failure, 76% had no evidence of clinically significant prostate cancer (grade 2 or higher recurrence), 90% had not required repeat focal high-intensity focused ultrasound and 91% remained free of radical treatment. Among those who experienced grade group 2 or greater recurrence, bilateral prostate cancer at diagnosis was found to be the sole predictor (P = .03).

Among the 58 men who underwent posttreatment biopsy, 10 had in-field and eight had out-of-field grade group 2 or greater positive biopsy.

All men maintained continence. Before and after hemigland high-intensity focused ultrasound, median IIEF-5 scores were 22 vs. 21 and median I-PSS scores were 9 vs. 6 (P = .005).

Researchers reported no cases of rectal fistula, major complications or deaths. Minor 90-day complications occurred among 13% of men.

“Partial prostate cancer gland ablation with high-intensity focused ultrasound provides an opportunity for prostate cancer treatment while maintaining patients’ quality of life,” Abreu said. “Radical treatments for men with prostate cancer are effective but are also frequently associated with side effects such as worsening urinary, sexual and bowel functions, including urinary incontinence, impotency or no erections and bloody stools. Focal high-intensity focused ultrasound ablation is safe and provides excellent potency and continence preservation with adequate short-term cancer control.”

The results mirror those previously reported that showed encouraging disease control and excellent preservation of genitourinary function with focal therapy, according to an editorial accompanying the study by Massimo Valerio, MD, PhD, research associate in the department of surgery and anesthesiology urology unit at Lausanne University Hospital in Switzerland.

“Although this study has the inherent limitations of a retrospective analysis, the authors deserve credit for having quickly and safely adopted this technology in their program,” Valerio wrote. “This might serve as an example for novel centers implementing partial gland ablation.”

References:

Abreu AL, et al. J Urol. 2020;doi:10.1097/JU.0000000000001126.

Valerio M. J Urol. 2020;doi:10.1097/JU.0000000000001126.01.

For more information:

Andre L. Abreu, MD, can be reached at Keck School of Medicine of USC, 1441 Eastlake Ave., Suite 7416, Los Angeles, CA 90089; email: andre.abreu@med.usc.edu.