Photo Credit: evgenyatamanenko

The following is a summary of “Whole-gland or Subtotal High-intensity Focused Ultrasound Versus Radical Prostatectomy: The Prospective, Noninferiority, Nonrandomized HIFI Trial,” published in the December 2024 issue of Urology by Ploussard et al. 

Researchers conducted a retrospective study comparing high-intensity focused ultrasound (HIFU) and radical prostatectomy (RP) for localized prostate cancer (PC). HIFU showed similar outcomes to RP with less impact on urinary continence and erectile function. 

They performed a prospective nonrandomized nationwide trial across 46 centers in France, comparing RP and HIFU for low- to intermediate-risk PC. The primary endpoint was salvage therapy–free survival (STFS), with secondary endpoints including metastasis-free survival (MFS), PC-specific survival, overall survival (OS), and functional outcomes. 

The results showed that 3,328 patients were included (1967 HIFU, 1361 RP). Median age was 74.7 years in the HIFU group and 65.1 years in the RP group (P < 0.001), while median PSA was 7.1 ng/ml vs 6.9 ng/ml (P = 0.5). Intermediate-risk PC was found in 61% of HIFU patients and 64% of patients with RP (P = 0.10). The 30-month STFS was not inferior in the HIFU group (HR 0.71, 95% CI 0.52–0.97; P = 0.008). About 10% of HIFU patients experienced urinary retention. Grade >IIIa complications occurred in 54/1967 HIFU cases and 29/1361 RP cases (P = 0.3). Fewer HIFU patients had deterioration in 12-month urinary continence (29% vs 44%) and a lower decrease in IIEF-5 score (−7 vs −13). Internal Prostate Symptom Scores and quality-of-life (QoL) scores were similar in both groups. 

They concluded that whole-gland or subtotal HIFU provided comparable medium-term STFS outcomes to RP, with less impact on urinary continence and erectile function. However, these results were limited by the lack of randomization and age differences between groups. 

Source: europeanurology.com/article/S0302-2838(24)02701-5/abstract