Prostate Cancer Treatment Side Effects Comparison: Focal HIFU vs Surgery and Radiation

Several studies have been published recently that report the prostate cancer treatment side effect profiles. The article below will summarize some fo those findings and compare side effects of different types of treatment for prostate cancer.

The Studies

Focal HIFU

Last week a paper was published from a study in the UK on 625 men with prostate cancer treated with Focal HIFU in the prestigious journal European Urology, reporting outstanding five-year results in terms of disease control and side effect profile. The majority of men in thsi study at medium to high risk disease. Additionally, men in the study were followed for as long a 10 years with the average follow up time just under 5 years.

The study shows that after 1-2 years 97% of men were continent (as defined by no need to wear any pad for urinary leakage) and 2-3 years after focal HIFU 98% of men had no issues with incontinence. Additionally, although not reported in the official publication, Appendix Data indicates that erections sufficient for penetration were maintained in 85% of men who were able to achieve an erection sufficient for penetration prior to focal HIFU.

Surgery and Radiation Therapy

The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a longitudinal, population-based, prospective observational cohort study designed to measure the effectiveness and harms of contemporary management strategies for men diagnosed with localized prostate cancer (NCT0136286).

Patients in CEASAR were accrued from five Surveillance, Epidemiology, and End Results (SEER) registry catchment areas (Louisiana, New Jersey, Utah, Atlanta, and Los Angeles). This dataset was augmented with a sample of men enrolled in Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). A total of 3,709 participants were enrolled in CEASAR between 2011 and 2012. Questionnaire data was available for 2117 men. Prostatectomy (RP) was the treatment used in 1,291 men and radiation therapy (RT) was used in 680 men.

Side Effects Compared

Using the definition for incontinence of “no pads no leakage,” and the definition for erectile function of “erectile function sufficient for intercourse,” the following table compares the results of the two studies:

Incontinence

No pads, no leakage reported after the following procedures:

  • Focal HIFU: 80%
  • Radical Prostatectomy: 32%
  • Radiation Therapy: 53%

Erectile Function

Erection sufficient for penetration reported after the following procedures:

  • Focal HIFU: 85%
  • Radical Prostatectomy: 30%
  • Radiation Therapy: 28%

The results listed above for RP and RT from the CEASAR trial were calculated using presented risk stratified results that were combined appropriately to produce a single score. It is not clear from the article whether the CEASAR values were adjusted for baseline. In a prior CEASAR paper, 17% pretreatment leakage and 45% erectile dysfunction was reported in the study population. If the values reported in the three-year CEASAR follow-up paper in fact were not adjusted for baseline, adjusting them would result in “no pads no leakage” values of 39% for surgery and 64% for RT, and in “erectile function sufficient for penetration” values of 55% for surgery and 51% for RT, still quite lower than the 80% and 85% respectively for complete continence and erectile function sufficient for penetration reported with focal HIFU.

Conclusion

Despite a higher risk population (medium to high risk patients), focal HIFU resulted in a much higher in lower incontinence rates and much lower issues with erectile function. In addition, men who receive focal HIFU are back home on over-the-counter pain medication the same day, back to work within one-two days, and able to resume all activities of daily living within the same timeframe. This contrasts dramatically with the multiweek recovery and limitation of activities experienced by men who undergo prostatectomy, and the multi-month daily visits required for a course of radiation therapy.

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