A recent French trial comparing the efficacy of High-Intensity Focused Ultrasound (HIFU) and Radical Prostatectomy (RP) as primary treatments for localized prostate cancer has provided interesting insights. The study, led by Pascal Rischmann, MD, PhD, from the Toulouse Academic Hospital, found that HIFU was non-inferior to surgery in terms of salvage treatment-free survival rates after 30 months. This is the first prospective study to directly compare the outcomes of these two treatment modalities for patients with low- or intermediate-risk prostate cancer.
The HIFI study involved 3,328 patients across 46 centers in France, with 1,967 patients receiving HIFU and 1,361 undergoing RP. The patients included in the study had specific criteria such as low- or intermediate-risk prostate cancer, maximum four sextants invaded out of six on multiparametric MRI, and a minimum age requirement for each treatment arm. The patients who received HIFU had a median age of 74.7, while those who underwent RP had a median age of 65.1. The baseline characteristics, including PSA level, Gleason score, and clinical stage, were comparable between the two groups.
One of the key findings of the study was the significantly higher salvage treatment-free survival rate in patients treated with HIFU compared to RP. Patients who underwent HIFU had better functional outcomes in terms of urinary continence and erectile function, with lower rates of complications observed in the HIFU group. Additionally, the study showed that there was no significant difference in overall survival or cancer-specific survival between the HIFU and RP groups, suggesting that both treatments are equally effective in controlling the disease.
The study reported that patients who received HIFU had lower rates of urinary incontinence and erectile dysfunction compared to those who underwent RP. The stress incontinence scores and erectile function outcomes were significantly better in the HIFU group at both 12 and 30 months follow-up. Despite the differences in age between the two groups, there was no significant variation in the quality of life scores, indicating that both treatments had comparable impacts on the overall well-being of the patients.
In terms of safety, the study noted that complications greater than IIIa were reported in a small percentage of patients in both the HIFU and RP groups. The rates of complications were slightly higher in the HIFU group, but overall, the study concluded that both treatments have acceptable safety profiles. The findings suggest that HIFU is a viable alternative to RP for patients with localized prostate cancer, offering comparable oncological outcomes with improved functional results and quality of life.
The comparison between HIFU and RP in the treatment of localized prostate cancer presents promising results, highlighting the potential of HIFU as a primary therapeutic option for patients with low- or intermediate-risk disease. The study’s findings emphasize the importance of considering not only oncological outcomes but also functional results and quality of life when choosing the appropriate treatment for prostate cancer patients. Further research and long-term follow-up studies are needed to validate these results and establish the role of HIFU in the management of localized prostate cancer.
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