No AccessJournal of UrologyAdult Urology1 Jan 2015

Improved Outcomes with Advancements in High Intensity Focused Ultrasound Devices for the Treatment of Localized Prostate Cancer

    View All Author Information


    We evaluated the association between long-term clinical outcomes and morbidity with high intensity focused ultrasound.

    Materials and Methods:

    We included patients with stage T1c-T3N0M0 prostate cancer who were treated with Sonablate® (SB) devices during 1999 to 2012 and followed for more than 2 years. Risk stratification and complication rates were compared among the treatment groups (ie SB200/500 group, SB500 version 4 group and SB500 tissue change monitor group). Primary study outcomes included overall, cancer specific and biochemical disease-free survival rates determined using Kaplan-Meier analysis (Phoenix definition). Secondary outcomes included predictors of biochemical disease-free survival using Cox models.


    A total of 918 patients were included in the study. Median followup in the SB200/500, SB500 version 4 and the SB500 tissue change monitor groups was 108, 83 and 47 months, respectively. The 10-year overall and cancer specific survival rates were 89.6% and 97.4%, respectively. The 5-year biochemical disease-free survival rate in the SB200/500, SB500 version 4 and SB500 tissue change monitor group was 48.3%, 62.3% and 82.0%, respectively (p <0.0001). The overall negative biopsy rate was 87.3%. On multivariate analysis pretreatment prostate specific antigen, Gleason score, stage, neoadjuvant androgen deprivation therapy and high intensity focused ultrasound devices were significant predictors of biochemical disease-free survival. Urethral stricture, epididymitis, urinary incontinence and rectourethral fistula were observed in 19.7%, 6.2%, 2.3% and 0.1% of cases, respectively.


    Long-term followup of patients with high intensity focused ultrasound demonstrated improved clinical outcomes due to technical, imaging and technological advancements.


    • 1 American Cancer Society: Cancer Facts & Figures 2014. Available at Accessed March 8, 2014. Google Scholar
    • 2 : EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol2014; 65: 124. Google Scholar
    • 3 : Cancer progression and survival rate following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol2004; 172: 910. LinkGoogle Scholar
    • 4 : Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med2014; 370: 932. Google Scholar
    • 5 : Outcome and toxicity for patients treated with intensity modulated radiation therapy for localized prostate cancer. J Urol2013; 190: 521. LinkGoogle Scholar
    • 6 : Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys2013; 85: 686. Google Scholar
    • 7 : Multi-institutional analysis of long-term outcome for stage T1-T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys2007; 67: 327. Google Scholar
    • 8 : Ten-year biochemical disease control for patients with prostate cancer treated with cryosurgery as primary therapy. Urology2008; 71: 515. Google Scholar
    • 9 : Laparoscopic radical prostatectomy for localized prostate cancer: a systematic review of comparative studies. J Urol2006; 175: 2011. LinkGoogle Scholar
    • 10 : Oncological outcomes after robot-assisted radical prostatectomy: long term follow-up in 4,803 patients. BJU Int2013; . Epub ahead of print. Google Scholar
    • 11 : Treatment of prostate cancer with transrectal focused ultrasound: early clinical experience. Eur Urol1996; 29: 174. Google Scholar
    • 12 : Transrectal high-intensity focused ultrasound for the treatment of localized prostate cancer: eight-year experience. Int J Urol2009; 16: 881. Google Scholar
    • 13 : High-intensity focused ultrasound therapy for prostate cancer. Int J Urol2012; 19: 187. Google Scholar
    • 14 : Fourteen-year oncological and functional outcomes of high-intensity focused ultrasound in localized prostate cancer. BJU Int2013; 112: 322. Google Scholar
    • 15 : Evolution and outcomes of 3 MHz high intensity focused ultrasound therapy for localized prostate cancer during 15 years. J Urol2013; 190: 702. LinkGoogle Scholar
    • 16 : Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. Eur Urol2014; 65: 907. Google Scholar
    • 17 : Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys2006; 65: 965. Google Scholar
    • 18 : Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg2004; 240: 205. Google Scholar
    • 19 : The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. Int J Impot Res2002; 14: 245. Google Scholar
    • 20 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Crossref, MedlineGoogle Scholar
    • 21 : Transurethral resection of the prostate immediately after high-intensity focused ultrasound treatment for prostate cancer. Int J Urol2010; 17: 924. Google Scholar
    • 22 : Will focal therapy become a standard of care for men with localized prostate cancer?. Nat Clin Pract Oncol2007; 4: 632. Google Scholar
    • 23 : Morbidity of focal therapy in the treatment of localized prostate cancer. Eur Urol2013; 63: 618. Google Scholar