Partial vs. whole-gland salvage hifu after radiotherapy failure: oncological and functional outcomes

To evaluate the long-term oncological and functional outcomes of whole-gland and partial-gland salvage high-intensity focused ultrasound (S-HIFU) in patients with radiorecurrent prostate cancer, for whom local recurrence after radiotherapy remains a major therapeutic challenge and radical salvage surgery is associated with substantial morbidity.

We performed a retrospective single-center study including 138 patients treated with S-HIFU between August 2006 and October 2023 for biopsy-proven local recurrence without metastatic disease. Treatments consisted of whole-gland or partial-gland ablation, including hemi-gland and focal therapy. Oncological outcomes were assessed using Kaplan-Meier analyses and multivariable Cox regression models evaluating progression-free survival (PFS), metastasis-free survival (MFS), and cancer-specific survival (CSS). Postoperative complications were graded according to the Clavien-Dindo classification.

After a median follow-up of over five years, 5-year PFS, MFS, and CSS rates were 43.6%, 85%, and 95%, respectively. Higher pre-HIFU prostate-specific antigen (PSA) levels and ISUP grade ≥ 5 independently predicted disease progression. No significant differences in PFS or MFS were observed between whole-gland and partial-gland treatments. Acute urinary retention occurred in 33% of patients and voiding dysfunction in 39.9%, requiring surgical management in 34.1% of cases. Severe complications were significantly more frequent after whole-gland compared with partial-gland S-HIFU (48.3% vs. 29.8%, p < 0.05).

S-HIFU represents a viable salvage option after radiotherapy failure. Our results support that partial-gland S-HIFU significantly reduces severe morbidity while maintaining comparable oncological outcomes compared to whole-gland S-HIFU in appropriately selected patients.