High-Intensity Focused Ultrasound For Localized Prostate Cancer: Initial Experience With A 2-Year Follow-Up

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Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology;  MRI / PET / Ultrasound
Article Date: 07 Jun 2009 - 7:00 PDT

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UroToday.com - The diagnosis of localised prostate cancer is increasing due to increased awareness and increased testing. There are a number of treatment options available to many of these men, including surgery, radiotherapy, active surveillance and a range of new modalities including high intensity focused ultrasound (HIFU).

• Large numbers of men with localised disease are looking for treatments that minimise their morbidity (continence and erectile function) whilst maximising oncological effectiveness.


• There is often significant initial enthusiasm for new technologies due to huge range of technological innovation in medicine today; however, treatments for localised prostate cancer need at least a 10 year follow-up to show efficacy over standard techniques.


• Much of this enthusiasm is generated by companies that have invested heavily in these new technologies and often market them aggressively, irresponsibly and unwisely with immature data. It is suggested that HIFU is morbidity-free with better oncological outcomes than traditional treatments.


• National medical bodies can also be drawn in by publicity; such as the National Institute for Clinical Excellence (NICE) in the UK, which initially supported HIFU but has subsequently changed its guidance and now recommend using it only within clinical trials.


• Early HIFU case studies showing promising results have been widely publicised generating more clinician awareness and interest, and proponents of this technique have gained notoriety presenting their data internationally.


• There is a huge publication bias in surgical trials as positive results have a much better chance of being published, are published earlier, and are published in journals with higher impact factors. Conclusions exclusively based on published studies, therefore, can be misleading and selective underreporting of research might be widespread and more likely to have adverse consequences for patients than publication of deliberately falsified data. This publication bias is likely to apply to HIFU.


• There is a significant lack of good quality outcomes and efficacy data as patients often refuse to enter randomised controlled surgical trials.


• In our hands, HIFU was unable to match traditional treatment modalities (minimally-invasive radical prostatectomy, external beam radiotherapy or brachytherapy) for oncological efficacy. In addition it generated significant and devastating complications in some patients.


• We would urge urologists against commencing a HIFU programme until high quality long-term data becomes available as we seriously question its safety and ability to cure localised prostate cancer.

Written by Benjamin J. Challacombe, Declan G. Murphy, Rhana Zakri and Declan J. Cahill as part of Beyond the Abstract on UroToday.com

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