HIFU as first-line therapy in intermediate- and high-risk patients
Posted Mar 22 2011 12:00am
A report from an Italian clinical research group has offered data from > 150 patients treated with high-intensity focused ultrasound (HIFU) with an average of > 5 years of follow-up. Unfortunately the original paper is published in Italian, and so (since we can’t speak or read Italian) we can only comment on the data presented in the English version of the paper’s abstract.
Between May 2002 and June 2010, Callea et al. report that they used HIFU to treat 171 patients who had had no previous treatment for prostate cancer.
The key data from their abstract are as follows:
The average (mean) age of the patients was 74.7 years (range, 44 to 86 years).
Patients could be categorized into one of three prognostic risk groups.
149/171 patients received a single HIFU treatment.
22/171 patients were given a second HIFU treatment for one of two reasons.
At a mean follow-up of 67.9 months (about 5 years and 8 months), biochemical progression-free survival rates (defined by a PSA level constantly < 0.5 ng/ml) were as follows:
This series of patients had a comparable risk profile to those in the series of patients previously reported by Ahmed et al. in 2009. However, the 5-year follow-up is significantly longer.
The authors conclude with the comment that, “HIFU seems to be a promising alternative and less invasive treatment modality with an encouraging success rate, at least in the short-term, in patients with low and medium risk of progression [who are] not candidates for radical surgery.” They also note that about half the patients with even high-risk disease seem to get acceptable results.
Unfortunately the English abstract of this paper provides no data about the side effects of treatment, and there is no indication in the abstract whether the research team was working with Sonablate or Ablatherm equipment; however, the definition of PSA failure (i.e., 0.5 ng/ml) was the same as that used by Ahmed and his colleagues.
It is extremely difficult to know how to interpret such data without being able to review the full paper. However, we are likely to see this paper being quoted as a source for the successful use of HIFU in the treatment of intermediate- and high-risk prostate cancer by some people, so we offer the available data here for context.
The biochemical progression-free survival rate of just 43.1 percent among the high-risk patients in this series (regardless of adverse effects) does not suggest to The “New” Prostate Cancer InfoLink that HIFU is a particularly effective way to consider treating such men. There is a better than 50:50 chance that they will need salvage therapy within 5 years, and to date we have little information on the effectiveness or safety of treatments for men who are unsuccessfully treated with HIFU as their first-line therapy for supposedly localized disease..