Recent Reports About HIFU 'Troubling'

Gerald Chodak, MD


February 07, 2018

Hello. I'm Dr Gerald Chodak for Medscape, wishing you a happy and healthy new year. Today's topic is high-intensity focused ultrasound (HIFU), something that I've commented on several times in past years.

This topic is prompted by two [journal] reports appearing on Medscape. The first was a small study by Tay and colleagues.[1] Fourteen men with low-risk prostate cancer (Gleason score of 3+3 and one or two lesions identified on MRI measuring no more than 10 mm3) received [focal therapy with in-bore magnetic resonance–guided focused ultrasound]. They did quality-of life-surveys and biopsies at 6 and 24 months. Thus far, 12 of the 14 men have been followed for 24 months. Of those biopsied, a quarter of them had greater than Gleason 6 disease on their subsequent biopsy. In other words, a quarter of the men failed this therapy with disease progression.

The second report, by Schulman and colleagues,[2] was essentially a commentary advocating HIFU therapy as a focal treatment. The argument they make is that many men cannot cope with active surveillance and do not want to face the side effects of definitive therapy. Administering HIFU, even if it fails, would allow them to undergo the treatment a second time and hopefully prevent the need for definitive therapy. In other words, rather than dealing with the psychological trauma a man is facing, it's better to do something for them even if that treatment does not turn out to have a real impact. Their conclusion is that HIFU is a reasonable option to consider and explore further.

I am very troubled by these two reports and by the idea of focal therapy for prostate cancer. As yet, not one study really proves its value. We do not know whether it prevents disease progression. We do not know how often it might prevent men from needing definitive therapy. And we certainly do not know whether it impacts survival. Early reports of HIFU showing similar survival to active surveillance for low-risk disease is not proof that it's a good therapy to offer patients.

I'm uncertain about whether definitive studies will ever be done to find out whether this is a good therapy to offer men. Until that time, many men may undergo this therapy or be advised to have this therapy without the proper support.

I look forward to your comments. Thank you.


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