A Systematic Review on HIFU for Prostate Cancer

Objective: Prostate cancer is the second- leading cause of cancer death among men.
We aimed to evaluate high-intensity focused ultrasound (HIFU), open radical prostatectomy
(ORP), robot-assisted radical prostatectomy (RARP), and external beam radiation
therapy (RT) in the treatment of localized low- and intermediate-risk prostate cancer.

Methods: We searched bibliographic databases for case–control, cohort, and randomized
controlled studies. We used MeSH subject headings and free text terms for prostate
cancer, HIFU, ORP, RARP, RT, failure-free survival (FFS), biochemical disease-free
survival (BDFS), urinary incontinence (UI), and erectile dysfunction (ED).

Results: Fourteen studies were included in the review, for a total of 34 927 participants.
Among the 8 studies of HIFU as the primary treatment of localized low- and intermediate-
risk prostate cancer, 4 studies reported 5-year FFS rates ranging from 67.8% to
97.8%, 3 studies reported 5-year BDFS ranging from 58% to 85.4%, 5 studies reported
1-year UI rates ranging from 0% to 6%, and 4 studies reported 1-year ED rates ranging
from 11.4% to 38.7%. Furthermore, our search revealed a 5-year FFS benefit favoring
ORP compared to RT, a 1-year UI rate favoring ORP compared to RARP, and a 1-year ED
rate favoring ORP compared to RARP.

Conclusion: Our systematic review and meta-analysis revealed lack of studies with
active comparators comparing HIFU to standard of care (ORP, RARP, or RT) in primary
treatment of localized low- and intermediate-risk prostate cancer. Open radical prostatectomy
has favorable efficacy outcomes compared to RT, while RARP has beneficial
functional outcomes compared to ORP, respectively.

Cite this article as: Toeama B, Papadimitropoulos E, Perlis N, Grootendorst P, Hamandi B. A systematic review and
meta-analysis of the cancer-related and functional outcomes of high intensity focused ultrasound, open radical
prostatectomy, robot assisted radical prostatectomy, and external beam radiation therapy in primary treatment of localized
low or intermediate risk prostate cancer. Urol Res Pract. 2024;50(1):1-12.