The Comparison Between High-Intensity Focused Ultrasound (HIFU) and Radical Prostatectomy (RP)

The study conducted in France comparing high-intensity focused ultrasound (HIFU) and radical prostatectomy (RP) as primary treatments for localized prostate cancer found that HIFU was non-inferior to surgery. Patients treated with HIFU had a significantly higher salvage treatment-free survival rate compared to those who underwent RP. The study, known as the HIFI study, was a non-inferiority, prospective, non-randomized study involving 3,328 patients in 46 centers across France from April 2015 to September 2019.

Results of the study showed that patients treated with HIFU had better functional outcomes in terms of urinary continence and erectile function. The salvage treatment-free survival after HIFU was not inferior to radical prostatectomy. Moreover, complications greater than IIIa were reported in a lower percentage of patients who underwent HIFU compared to RP. In addition, patients in the HIFU arm had better functional results with lower rates of urinary incontinence and erectile dysfunction than those in the RP arm.

The study included patients with low- or intermediate-risk prostate cancer and a maximum of four sextants invaded out of six on multiparametric MRI. Patients in the HIFU arm had a median age of 74.7, while those in the RP arm had a median age of 65.1. Most patients had intermediate-risk disease, and there was an even split between patients classified as grade group (GG) 1 and those >1. Overall survival was similar between the two groups, with no significant difference after adjusting for age. Cancer-specific survival was 100% in both arms, and no deaths were attributed to treatment.

The findings from this study suggest that HIFU could be a viable alternative to radical prostatectomy as a primary treatment for localized prostate cancer. With better functional outcomes and comparable survival rates, HIFU may offer patients a less invasive treatment option with similar effectiveness. Further research and long-term follow-up studies are needed to validate these results and determine the optimal treatment approach for localized prostate cancer.