High intensity focused ultrasound: a treatment option for men with recurrent, localized prostate cancer previously treated with radiation

This paper evaluated the use of High Intensity Focused Ultrasound (HIFU) to treat recurrent prostate cancers that are confined to the prostate gland (T1 and T2) and that have previously been treated with External Beam Radiation Therapy (EBRT). HIFU treatment has led to minimal PSA levels, and negative biopsies in about 58% of the patients, and resulted in a 7-year survival rate of 80%.   

EBRT is an accepted treatment option for confined (localized) prostate cancer. Androgen deprivation therapy is often given to patients in addition to EBRT, to reduce the chances of the cancer reappearing (reoccurring, or recurring) or spreading to other locations. Treatment of a reccurrence is often called salvage-treatment. HIFU treatment is given using a machine that gives off high frequency sound waves. These waves deliver a strong beam to a specific part of a cancer.

This study included 290 men who received salvage HIFU treatment for recurrent, localized prostate cancer previously treated with EBRT. Information collected included: cancer-related characteristics prior to EBRT (categorized into low, intermediate or high risk cancers), prostate specific antigen (PSA) levels, Gleason scores before and after HIFU treatment and the length of progression free time (period until the cancer has progressed). 

Results showed that HIFU treatment shrunk the prostate gland, this limited the number of patients who could undergo a biopsy.  However, 208 patients did have a prostate biopsy and of these 169 were negative for cancer (58%). HIFU also reduced PSA levels. Minimum PSA levels were reached at approximately 5.5 months after treatment (in average), these levels were very low and well within normal levels in 176 of the patients.  Additionally, survival rates (the percentage of patients alive) at 5 and 7 years were 80% and 79.6% of patients, respectively.

In conclusion, this paper brings new evidence that support HIFU as a treatment option for men who have localized, recurrent prostate cancer following primary treatment with EBRT. There are however as with other treatments side effects caused by HIFU, the benefits of this treatment in light of these side effects should be discussed with your doctor.

This study is limited by the fact that HIFU treatment was given using three different models of equipment and without one standard treatment protocol. These inconsistencies may have affected treatment outcomes.