Technology review: high-intensity focused ultrasound for prostate cancer

High-Intensity Focused Ultrasound (HIFU) is a technology that has moved from being used for benign prostate disease to the treatment of prostate cancer. A technology review was undertaken to guide patients and physicians as to its suitability.

An evidence-based review of published papers in the English language, with additional material from internet and other sources.

Only case series have been published; there are no randomized studies. The quality of evidence is poor, with no reports having longer follow-up than a mean of 2 years, with median follow-ups substantially shorter. Efficacy outcomes are thus premature and preclude assessment. Toxicity varies substantially with impotence rates 44%-61%, grade 2-3 incontinence 0%-14%, and rectal fistulae 0.7%-3.2%. There is limited data on the use of HIFU for the salvage therapy after radiation failure. There are no data on the toxicity of subsequent standard curative therapies after HIFU. In view of the lack of efficacy outcomes, and in the presence of significant toxicity, HIFU should only be offered within a research setting.