Oncological long-term outcome of whole gland HIFU and open radical prostatectomy: a comparative analysis
To compare the oncological long-term efficacy of whole gland high-intensity focused ultrasound (HIFU) therapy and radical prostatectomy (RP) in patients with clinically localized prostate cancer.
418 patients after open RP (1997–2004) were compared with 469 patients after whole gland HIFU (1997–2009) without preselection. Oncological follow-up focused on biochemical relapse, salvage treatment, life status and cause-specific mortality. The univariate log rank test was used to compare both treatment options regarding overall survival (OS), cancer-specific survival (CSS), biochemical failure-free survival (BFS) and salvage treatment-free survival (STS). To adjust the treatment effect for further prognostic baseline variables, a multivariable Cox proportional hazards regression model was calculated for each end point.
Median follow-up was 13.3 years in the RP group and 6.5 years in the HIFU group. OS/CSS/BFS/STS rates at 10 years were 91/98/80/80% after RP and 76/94/70/71% after HIFU. HIFU therapy (reference RP) was a significant and independent predictor for an inferior OS, CSS and STS. In subgroup analysis, HIFU provided significantly reduced CSS for intermediate- (p = 0.010) and high-risk patients (p = 0.048); whereas no difference was observed in the low-risk group, intermediate-risk HIFU patients showed a significantly inferior STS (p = 0.040).
While whole gland HIFU offers a comparable long-term efficacy for low-risk patients, sufficient cancer control for high-risk patients is more than doubtful. For the subgroup of intermediate-risk patients, CSS rates seem to be comparable up to 10 years suggesting that HIFU may be an alternative for older patients, although a higher risk of salvage treatment should be expected.
KeywordsHIFU Radical prostatectomy Oncological outcome Prostate cancer
BR, JB: project development, data collection and analysis, manuscript writing; RG, AB, MB: manuscript editing; FZ: statistical analyses, manuscript editing; TN: data collection and analysis. HMF: project development, manuscript editing.
Compliance with ethical standards
Conflict of interest
Johannes Bründl served as a paid instructor for EDAP-TMS. Andreas Blana served as a paid consultant for EDAP-TMS. The other authors declare that they have no conflict of interests.
Research involving human participants and/or animals
This article does not contain any studies with animals performed by any of the authors.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol (reference number: 13-101-0272) was approved by the Ethics Committee of the University of Regensburg.
For this type of study formal consent is not required.