Who Should Consider HIFU as Treatment for Prostate Cancer?
Focal therapies, and HIFU specifically, have been proposed as alternative therapy for intermediate prostate cancer. For a certain subset of intermediate prostate cancer cases, ones where the cancer is limited to a specific region of the prostate, the idea of a localized treatment that only targets the cancer and does not treat the rest of the gland is a possibly appealing option. HIFU and other focal treatments have been documented to be able to ablate the cancer tissue while also offering reduced side effects and quicker recovery.
But does HIFU really live up to its promise? Research has delivered mixed results on the effectiveness of the treatment and the risk of recurrence. Some studies have found it to be non-inferior to surgery or radiation (“non-inferior” is medical terminology for “no worse than”). Others have reported reduced side effects but with higher recurrence rates. This leaves the patient with the question of whether the benefit is worth the risk.
The question of recurrence is an important one, and if you do some research, or ask various urologic oncologists, you will hear a wide range of rates of recurrence. So it was with great interest earlier this year that we learned UCSF was publishing results of a study they conducted to assess the use of HIFU and the risk of recurrence.
For anyone considering HIFU as their treatment option, the report should be required reading. The report confirmed the desired reduction in side effects. But the recurrence results should be taken seriously. Their patients had an overall 54% recurrence rate, with a 41% in-field recurrence rate after 12 months. (“In-field recurrence” suggests that HIFU did not successfully eliminate the target cancer.) The study goes on to explore why they think their results were higher than some previous studies.
The study also explores the correlation between pretreatment characteristics and ultimate results, suggesting that tight screening should be used in determining appropriate candidates.
For me, the report was very interesting as it hits very close to home. Just 12 months ago I had been offered HIFU by my doctor as his recommended treatment option. Luckily for me, I learned to ask enough questions and took the time to research the risks. And in the end, I wasn’t ready to accept the risk of recurrence and chose to go for a more aggressive approach to reduce my risk of having to treat again.
So if you are going to consider HIFU as a treatment option, be prepared to ask yourself the old Dirty Harry line: “Do You Feel Lucky?”
-Stuart Jordan
For more information or questions, please contact stuart@ancan.org.