HIFU method advantages
Delayed results for 15 years show high full recovery rates of 83–87%, low level of complications, and maintaining previous quality of patient's life.
The HIFU procedure does not put the Patient at a risk of a long and complicated surgery and prolonged recovery; no ionising radiation is used during the procedure.
An enormous advantage of the HIFU method is low patient's exposure to side effects, as well as an option for repeating the procedure in case of cancer recurrence.
What should also be noted is the possibility to perform the HIFU procedure after radiotherapy, brachytherapy or radical prostatectomy.
The main advantages of this procedure include:
- HIFU involves less side effects than standard procedures
- HIFU is not a radiotherapy - it is free of all problems associated with irradiation.
- HIFU is a minimally-invasive procedure
- HIFU does not require a long stay at the hospital
- The HIFU method may prolong patient's resistance to cancer.
HIFU method versus external beam radiotherapy
Specialists from the Edouard Herriot Hospital (Lyon, France) compare the use of the HIFU method and of external beam radiotherapy (EBRT) in patients with locally advanced prostate cancer.
190 patients were enrolled into the study, with comparable PSA levels and Gleason score before treatment initiation. Those patients were treated in a period between 2000 and 2005. Progression-free survival at five years did not differ significantly in observations after the HIFU method and external beam radiotherapy (EBRT).
Implementation of a palliative hormonal therapy was significantly more common in patients treated with radiotherapy, and this indicates the HIFU method is more advantageous for treatment of prostate cancer.
After 7 years of monitoring, survival parameters specific to the disease and metastasis-free survival rate were 87%, 100%, 100 % for HIFU, and 99%, 100% and 98% for EBRT, respectively (p=0.043, 0.932, 0.941).
Crouzet S, Chapelon JY, Rouviere O, et al. Whole Gland ablation of localized prostate cancer with high-intensity (2013).
Comparison between laparoscopic radical prostatectomy and HIFU method
A team of urologists from France compared a traditional method for prostate cancer treatment - radical prostatectomy (including the laparoscopic method) versus the HIFU method in patients with locally advanced cancer.
588 patients with similar Gleason score, PSA levels, and clinical condition were compared. Mean age of patients treated by surgery was 61 years and those treated by HIFU method was 65 years. The seven-year survival without salvage radiotherapy was lower in patients treated with the HIFU method versus radical prostatectomy, but what is important, the recurrence-free survival rate at five years for treatment of recurrence following initial radiotherapy was better in the group treated by HIFU than after radical prostatectomy (91% versus 75% , p:0.014).
Nine years of monitoring showed that both treatment methods have similar therapeutic effects, at the level of 90%.
In the world, radical prostatectomy, performed using the laparoscopic or the traditional method, still remains the main method for treatment of locally advanced prostate cancer. However, there are certain groups of patients in whom other treatment methods can be considered, with lesser trauma or better complications profile than in case of known complications of surgical treatment.
Results of well-designed scientific studies comparing results of treatment with various methods are very interesting and valuable. Those studies analyse patients with very similar disease parameters (matched pairs). This way advantages of each method can be compared in terms of evaluated parameters.
Although comparison of prostate cancer treatment results after prostatectomy and the HIFU method shows that HIFU treatment is less radical, yet better results were observed for treatment of local recurrence by radiotherapy following primary HIFU therapy versus treatment of recurrence post prostatectomy using the same method. What is important, after 9 years of monitoring, survival parameters specific to the disease and metastasis-free survival rate were similar for both methods - 89%, 97%, 94% for HIFU, and 89%, 97% and 97% for radical prostatectomy. (p=0.186, 0.312, 0.107).
Thuroff S, Chaussy C. Evolution and outcomes of 3 MHz high intensity focused ultrasound therapy for localized (2013).
When comparing results of treatment with the HIFU method and external beam radiotherapy (EBRT), researchers also compared matched pairs of patients. They did not find a statistically significant difference in progression-free survival after HIFU treatment and external beam radiotherapy (EBRT) (47% versus 52%, p=0.311). After 5 years, the percentage of patients not requiring palliative hormonal therapy differed significantly (85% post HFU versus 58% post EBRT, p=0.002). After 7 years of monitoring, survival parameters specific to the disease and metastasis-free survival rate were 87%, 100%, 100 % for HIFU, and 99%, 100% and 98% for EBRT, respectively (p=0.043, 0.932, 0.941). No statistically significant differences were found between those two methods in progression-free survival after 5 years of post-treatment monitoring, and patients receiving radiotherapy significantly more often required initiation of palliative hormonal therapy than those treated with HIFU.
Those results were presented at the annual meeting of the America urological Association in Orlando in 2014, and the team of Professor Sébastien Crouzet received the Best Poster award of the whole multi-thematic conference, out of thousands of submitted research results.
Comment prepared by: Marek Filipek, MD, PhD
Ablatherm®HIFU and Focal One®
The increasing number of men selects HIFU (High Intensity Focused Ultrasound) as a method for prostate cancer treatment. Since that method was introduced in Poland, over 120 HIFU procedures have been performed at our centre. It should be noted that an interest in this method increases not only amongst oncological patients - as positive results of clinical studies are reported by centres all over the world, an increasing number of urologists and oncologists propose this treatment method to their patients During last two years the HIFU method received important recommendations in guidelines of the European Association of Urology.
An increasing popularity of HIFU procedures also contributed to a robust development of the technology used during the procedure. At the end of 2013 a French company TMS-EDAP®, a manufacturer of the Ablatherm®HIFU device launched the Focal One® system into the market.
A new generation of equipment was developed to facilitate even more detailed planning and performance of the procedure. The therapy using Focal One® focuses mainly on treatment of small prostate cancer foci, according to the focal therapy principle (treatment involving a tumour alone, not the whole prostate). It is possible that in the future this approach to prostate cancer treatment will become a real therapeutic alternative for patients. As of today, guidelines of the European Association of Urology describe this procedure as an experimental therapy.
It should also be noted that the most common form of prostate cancer is multi-focal one, and that a crucial component required for patient qualification for a focal therapy is a MRI-guided multi-point transperineal biopsy - and it is not easy to have this examination performed in Poland.
Unfortunately, there are no available clinical studies or scientific reports confirming effectiveness of the therapy with the Focal One® device (previous studies concern solely treatment with the Ablatherm®HIFU device). The Ablatherm®HIFU device used at our centre is the only device with effectiveness confirmed by clinical studies covering more than ten years. When faced with a choice between those two tools, at this stage of technological development many renowned specialists prefer equipment verified by long-term clinical studies. While waiting for publication of first results of a therapy with the Focal One® device, our specialist make an informed choice of a therapy with Ablatherm®HIFU according to a verified protocol.