The comparison between High-Intensity Focused Ultrasound (HIFU) and Radical Prostatectomy (RP) as primary treatment options for localized prostate cancer has been a subject of interest in the medical field. A recent French trial conducted by Pascal Rischmann, MD, PhD, of Toulouse Academic Hospital, revealed some intriguing findings that shed light on the efficacy and outcomes associated with these treatment modalities.
The HIFI study, a non-inferiority, prospective, non-randomized trial, was conducted in 46 centers across France over a period of 4 years. The study included a total of 3,328 patients, with 1,967 patients receiving HIFU treatment and 1,361 patients undergoing RP. The eligibility criteria for the study included patients with low- or intermediate-risk prostate cancer, specific PSA levels, Gleason scores, and clinical stages, as well as age and life expectancy considerations.
At a follow-up of 30 months, patients treated with HIFU exhibited a significantly higher salvage treatment-free survival rate compared to those who underwent RP. This finding suggests that HIFU may be non-inferior to surgery as a primary treatment for localized prostate cancer. Furthermore, patients treated with HIFU demonstrated better functional outcomes in terms of urinary continence and erectile function.
The study reported that patients who received HIFU treatment had lower incidences of urinary incontinence and erectile dysfunction compared to those who underwent RP. Specifically, the percentage of patients experiencing stress incontinence and impaired erections was lower in the HIFU group at both 12 and 30 months post-treatment. This indicates that HIFU may offer advantages in terms of preserving urinary and sexual function.
In terms of safety, the study found that complications greater than grade IIIa were reported in a small percentage of patients in both the HIFU and RP groups. This suggests that both treatment modalities have acceptable safety profiles, with no significant differences in the incidence of severe complications between the two groups.
The findings of the HIFI study provide valuable insights into the comparative effectiveness of HIFU and RP as primary treatments for localized prostate cancer. The results suggest that HIFU may offer comparable oncologic outcomes and superior functional results compared to RP. However, further research and long-term follow-up are needed to fully assess the benefits and limitations of each treatment modality in the management of prostate cancer.
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