Survival Outcomes and Recurrence Patterns Following Focal High-intensity Focused Ultrasound Treatment for Localized Prostate Cancer: Insights on Patient Selection and Lessons Learned

Focal therapy is increasingly being used as a treatment for localized prostate cancer (PC). Our aim was to evaluate oncological outcomes, recurrence patterns, and survival after high-intensity focused ultrasound (HIFU), to discuss the lessons learned from our experience, and to propose strategies to enhance patient selection for HIFU treatment. Between 2016 and 2023, 113 patients underwent focal HIFU treatment for PC. Follow-up included prostate-specific antigen (PSA) measurement every 3 mo, magnetic resonance imaging, and a control biopsy performed at 6 or 12 mo. Recurrence was categorized on the basis of location (infield or out-of-field) and Gleason grade group (clinically significant [CS] vs non-CS) with stratification by National Comprehensive Cancer Network risk groups. Kaplan-Meier curves were used to analyze survival outcomes, recurrence rates, and the need for retreatment. Median follow-up was 29 mo and 92 patients (81%) had PSA follow-up for at least 12 mo. Local recurrence was observed in 34 patients (37%), which was CS in 16 (17%). The CS recurrence–free survival rate at 3 yr was worse for subgroups with high-risk or unfavorable intermediate-risk disease in comparison to the group with favorable intermediate-risk PC (40% and 53% vs 85%; log-rank p  < 0.01), with a higher rate of out-of-field recurrence in the high-risk group. The Kaplan-Meier retreatment-free survival rate estimate was 71% at 3 yr. Sixteen patients (17%) underwent salvage local treatment. Study limitations include the small cohort size and relatively short follow-up. HIFU is a promising alternative for localized PC in well-selected patients. However, patients with high-risk or unfavorable intermediate-risk PC are more likely to experience treatment failure. We examined cancer control outcomes after high-intensity focused ultrasound for localized prostate cancer. We found that the rate of cancer recurrence was higher for patients with higher-risk disease. However, this treatment is a feasible and acceptable option for patients with intermediate risk.