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Updated: Sep 13, 2025

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Determining Optimal Patient Selection for High-intensity Focused Ultrasound for Prostate Cancer.

Kevin Shee1, William A Pace1, Andrew W Liu1

  • 1UCSF Department of Urology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA, USA.

European Urology Focus
|August 3, 2025
PubMed
Summary
This summary is machine-generated.

High-intensity focused ultrasound (HIFU) for prostate cancer shows local recurrence risk factors including higher Gleason grade and genomic risk. Careful patient selection is key for effective HIFU treatment with minimal side effects.

Keywords:
Focal ablative therapyHigh-intensity focused ultrasound ablationProstate cancer

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Area of Science:

  • Oncology
  • Urology
  • Medical Imaging

Background:

  • High-intensity focused ultrasound (HIFU) offers a minimally invasive treatment for prostate cancer.
  • While effective, recurrence remains a concern, necessitating identification of predictive factors.
  • Optimizing patient selection is crucial for maximizing HIFU's therapeutic benefits.

Purpose of the Study:

  • To identify factors associated with recurrence after HIFU treatment for prostate cancer.
  • To evaluate treatment failure rates and impact on urinary and sexual function.
  • To refine patient selection criteria for HIFU therapy.

Main Methods:

  • Retrospective analysis of men undergoing robotic HIFU (FocalOne) with 1-year follow-up MRI-fusion biopsy.
  • Primary outcomes: in-field and overall biopsy-proven recurrence.
  • Secondary outcomes: treatment failure (salvage therapy, metastases), and functional outcomes (urinary/sexual).

Main Results:

  • Pre-HIFU Gleason grade ≥3 and high genomic risk score were linked to in-field recurrence.
  • Overall recurrence associated with Gleason grade ≥3 and PSA >10 ng/ml.
  • Treatment failure rate was 4% at 1 year, 16% overall; no significant changes in urinary/sexual function.

Conclusions:

  • Elevated pre-HIFU Gleason grade, high genomic risk score, and increased PSA predict local recurrence.
  • HIFU demonstrates efficacy in cancer control with preserved urinary and sexual function in selected patients.
  • These findings underscore the importance of meticulous patient selection for successful HIFU outcomes.