Evaluating the functional and oncologic outcomes of combining whole-gland high-intensity focused ultrasound ablation with transurethral resection of the prostate in patients with prostate cancer.

This study evaluated the functional and oncologic outcomes of combining whole-gland high-intensity focused ultrasound ablation (HIFU) with transurethral resection of the prostate (TURP) in patients with prostate cancer (PCa). The data showed that the combination treatment of whole-gland HIFU and TURP improved the urinary outcomes in these patients.

Transurethral resection of the prostate (TURP) is the most common surgery used to treat benign prostatic hyperplasia (BPH). BPH is a non-cancerous enlargement of the prostate gland. These patients often experience lower urinary tract symptoms (LUTS). These include symptoms such as difficulties emptying the bladder, urine leakage (incontinence), or getting up to urinate during the night. TURP involves removing some excess prostate tissue to reduce pressure on the urethra (the tube which carries urine from the bladder to outside the body).

HIFU is a treatment option for prostate cancer (PCa) that is limited to the prostate itself (localized). This means it has not yet spread beyond the prostate or to distant organs (metastasis). HIFU uses high-frequency ultrasound waves to heat and destroy cancer cells in the prostate. HIFU can be used in half of the prostate gland (hemi-gland) or on the whole prostate gland (whole-gland). Studies have shown that HIFU has favorable outcomes in low- and intermediate-risk groups of patients with PCa. However, there are few studies evaluating the functional and oncologic outcomes of combining whole-gland HIFU with TURP in patients with PCa.

This study analyzed 15 other studies and involved 1861 patients with PCa. 74.6% of patients had low-risk or intermediate-risk PCa and 25.4% of patients had high-risk PCa. All patients received a combination treatment of whole-gland HIFU and TURP.

Biochemical failure (BCF) was evaluated. If, after treatment, the prostate-specific antigen (PSA; a protein made by cells of the prostate gland) levels increased by 2 ng/ml from the lowest value it was considered evidence of BCF. The BCF rates ranged from 6.3% to 34% with an average time of 1.9-60 months. After the treatment, the average PSA lowest value (PSA nadir) ranged from 0.20 to 1.90 ng/mL. The average time to reach the PSA nadir ranged from 1.9 to 12 months.

Urinary incontinence occurred in 9.4%, urinary retention in 0.9%, urinary tract infections in 2.6%, and urinary obstruction in 4.3% of the patients. 43.6% of the patients were sexually potent after the procedure.

This study concluded that the combination treatment of whole-gland HIFU and TURP improved the urinary outcomes in patients with PCa.

The studies analyzed used two different HIFU devices- Ablatherm and Sonablate-500. This might affect the conclusions. The patients included in this study had different risks of PCa- 25% had high-risk PCa and 75% had low-risk or intermediate-risk PCa. Further studies with longer follow-ups are required to validate the conclusions.