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In addition to the therapies applied in our center established forms of therapy with reliable long-term results from international studies, treatments are also used in other clinics whose efficacy is not or not yet sufficiently proven or whose long-term side effects are unknown. According to the guidelines, treatment with the high-intensity focused ultrasound (HIFU) procedure is considered an experimental therapy and should therefore only be used in the context of studies. This was reconfirmed by leading experts at the 2018 annual meeting of the German Society of Urology (DGU).
High-intensity focused ultrasound, or HIFU for short, is a procedure for treating localized prostate carcinoma. In this procedure, focused ultrasound waves of high energy strike the prostate gland and destroy the tumor tissue through the strong effect of heat. Although the HIFU procedure is intensively advertised, the effectiveness of the therapy has not yet been sufficiently researched and proven in studies. Worldwide, significantly fewer prostate cancer patients have been treated with HIFU compared to established procedures. In addition, there is insufficient knowledge about side effects, which can occur years after completion of treatment.
Even though there has been experience with HIFU therapy for several years, the study results are still not very satisfactory. According to a study published back in 2010 in the British Journal of Urology.1 on HIFU therapy, 80 percent of men with localized prostate cancer had biochemical recurrence five years after treatment, indicating tumor regrowth in most cases. Accordingly, only 20 percent of men were considered cured after five years. Not much has changed since then. For example, a study published in April 20182 with data from prostate cancer patients from five German centers shows that tumor tissue was still detectable in more than one in four men one year after HIFU therapy. In a recent British study3 HIFU therapy had to be repeated in one in three patients with high-risk prostate cancer.
In contrast to benign prostate enlargement, prostate cancer usually develops in the area of the prostate capsule, and thus in the immediate vicinity of the rectum. HIFU treatment of the tumor therefore carries the risk of intestinal injury and fistula formation4. Due to the strong heat effect on the organ, in many cases the man's potency is also negatively affected. A partial potency-preserving treatment is possible, but this does not completely remove the prostate tissue, and thus the final elimination of the tumor is not guaranteed.
In order to treat prostate glands with a larger volume by means of HIFU therapy, the prostate must be surgically reduced in size (TURP) in advance, as otherwise sufficient energy cannot be reached in the inner zones of the organ. In this case, it is no longer possible to speak of a "minimally invasive procedure".
Literature:
1RipertT et al: Six years' experience with high-intensity focused ultrasonography for prostate cancer: oncological outcomes using the new 'Stuttgart' definition for biochemical failure. BJU Int. 2010 Nov 17.
2GanzerR, Hadaschik B, Pahernik S et al: Prospective Multicenter Phase II Study on Focal Therapy (Hemiablation) of the Prostate with High Intensity Focused Ultrasound. J Urol. 2018 Apr;199(4):983-989.
3GuillaumierS, Peters M, Arya M et al: A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically SignificantNonmetastatic Prostate Cancer. Eur Urol. 2018 Oct;74(4):422-429.
4NetschC, Bach T, Gross E, Gross AJ. Rectourethral Fistula After High-intensity Focused Ultrasound Therapy for Prostate Cancer and Its Surgical Management. Urology. 2011 Jan 5.
