Introduction:

While focal therapy has been increasingly adopted as a treatment alternative to whole gland treatment for localized prostate cancer, there remains a significant need for data on survival outcomes. In this manuscript, we evaluate oncologic outcomes, including recurrence patterns and survival outcomes, in a prospective cohort of patients. Furthermore, we provide a detailed discussion of the lessons learned from our findings and propose strategies to enhance patient selection for HIFU treatment.

Methods:

Between 2016 and 2023, 113 patients underwent focal HIFU treatment for prostate cancer. Follow-up included PSA every 3 months and prostate MRI. As per the study protocol, a control biopsy was performed at 6 or 12 months. Recurrence was categorized based on location (infield or outfield) and Gleason grade group (clinically significant vs. non-clinically significant recurrence). Kaplan-Meier curves were utilized to analyze survival outcomes, recurrence rates, and the need for retreatment.

Results:

Of the 113 patients, 92 (81%) had follow-up with PSA for at least 12 months. The median follow-up was 29 months. The overall local recurrence rate was 37%. Clinically significant recurrences were detected in 16 (17%) patients, with 11 (68%) being infield and 5 (32%) outfield. Non-clinically significant recurrences were observed in 18 (19.5%) patients. 2 patients progressed to N1 disease. Clinically significant recurrence-free survival (CS-RFS) outcomes were notably poorer in patients with high and unfavorable intermediate NCCN risk groups compared to those with favorable intermediate-risk groups (15% and 43% vs. 77% CS-RFS at 5 years, Log-rank p of 0.001 and 0.03, respectively). Kaplan-Meier estimates for retreatment-free survival were 92%, 82%, and 74% at 12, 24, and 36 months, respectively. Additionally, 15 (27%) patients underwent salvage local treatment.

Conclusion:

Focal therapy is a promising alternative for localized prostate cancer in well selected patient. In our experience, patients with high risk or unfavorable intermediate risk Pca have higher probability of treatment failure. The characterization of post-HIFU recurrence patterns is essential for evaluating therapeutic efficacy and electing subsequent salvage interventions when necessary.

Funding: n/a