Arvin George, MD, presented “High Intensity Focused Ultrasound for Prostate Cancer: Guidelines, Complications, and Outcomes” during the 31st International Prostate Cancer Update in July 2021 in Snowbird, Utah.
How to cite: George, Arvin. “High Intensity Focused Ultrasound for Prostate Cancer: Guidelines, Complications, and Outcomes.” July 2021. Accessed Jul 2024. https://grandroundsinurology.com/high-intensity-focused-ultrasound-for-prostate-cancer-guidelines-complications-and-outcomes/
High Intensity Focused Ultrasound for Prostate Cancer: Guidelines, Complications, and Outcomes
Arvin George, MD, Assistant Professor of Urology at the University of Michigan in Midland, Michigan, reviews high intensity ultrasound (HIFU) for prostate cancer and outlines guidelines, patient selection, complications, and outcomes for the treatment. The NCCN guidelines state that HIFU is included as a salvage option after prior treatment failure, specifically radiation failure, but is not recommended as routine primary therapy due to lack of long-term comparative data. The EAU guidelines say to only offer HIFU within clinical trials or well-designed prospective cohorts. Dr. George describes the ideal HIFU patient as having unifocal, clinically-significant, and MRI-visible disease that has an absence of high-risk features. He then goes over a list of common complications and their rates of occurrence: retention (7-27%), hematoma (0-1.6%), sloughing (3-8%), urinary tract infection (5-18%), orchitis (2-8%), abscess (1-2%), fistula (.3-3%), pain (.5-3%), erectile dysfunction (12-30%), incontinence (0-5%), and stricture (2-4%). Dr. George says that to prevent complications one should not retreat the posterior zone, and should plan above the capsule while avoiding near field heat. He then reviews a study on focal therapy compared to radical prostatectomy for non-metastatic prostate cancer that found mostly HIFU focal therapy to have a failure free survival (FFS) rate comparable to that of radical prostatectomy, never exceeding a difference of 13%. Dr. George also discusses another study of medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer which showed FFS rates of 86% at 24 months, 64% at 60 months, and 54% at 96 months. He concludes with a final study which consolidated and compared HIFU’s outcomes to those of active monitoring, radiotherapy, and radical prostatectomy, showing that HIFU produces consistently better quality of life outcomes.
About The 31st Annual International Prostate Cancer Update:
The International Prostate Cancer Update (IPCU), founded in 1990, is a multi-day CME conference focused on prostate cancer treatment updates with expert, international faculty. It is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer. Dr. George delivered this educational activity during the 31st iteration of the meeting in July 2021 in Snowbird, Utah.
ABOUT THE AUTHOR
Arvin George, MD, serves as Director of Prostate Cancer Programs and Associate Professor (PAR) of Urology at Johns Hopkins School of Medicine in Baltimore, Maryland. He is a urologic surgeon who specializes in the diagnosis and management of genitourinary cancers. After obtaining his medical degree from the Royal College of Surgeons in Ireland, he completed his urology residency at the Smith Institute for Urology at the Hofstra North Shore-LIJ School of Medicine. He remained there to complete his endourology fellowship in New York, gaining additional subspecialty expertise in robotic, laparoscopic, and percutaneous surgery. Subsequently, he completed a urologic oncology fellowship at the National Cancer Institute of the National Institutes of Health. Dr. George’s research interests include minimally-invasive and image-guided treatments, functional prostate imaging, and focal therapy for prostate cancer. His research aims to identify appropriate use for imaging in diagnosis, risk stratification, and management of prostate cancer, including active surveillance and selection/treatment of patients with novel focal therapy modalities.
