[Scientific evidence on the use of high-intensity focal ultrasound (HIFU) in the treatment of prostatic carcinoma].
OBJECTIVE
To evaluate in the literature scientific evidence on the use of High-Intensity Focal Ultrasound (HIFU) in the treatment of prostatic carcinoma (PC).


METHODS
Three database are searched: PubMed, Cochrane Library, HTA database. Several articles were selected taking into account number of cases, inclusion criteria, duration of follow-up period. We have evaluated the best evidence available through a systematic review of clinical efficacy and cost-effectiveness of HIFU in the treatment of PC. We analized global survival, disease-free survival, and quality of life, including complications, adversal effects and acceptance of the technique.


RESULTS
Publications available are focused on two main indications of the therapy: first step of management of PC and salvage therapy for locally recurrent PC after external beam radiotherapy. It was very difficult to draw conclusions on the relative benefits of the HIFU: lack of high or medium quality evidence and no comparisons between this technique an standard treatments. In relation to results on cost-effectiveness, no relevant studies were identified in order to get conclusions on the quality of the treatment. Most of reports offered disparity in the definition of free survival disease concept. This fact produce some misunderstanding of results and conclusions cannot be drawn correctly. Inclusion criteria were also heterogeneous between authors.


CONCLUSIONS
No high-quality clinical evidence can be established currently on the utility of HIFU as treatment of prostatic cancer. An important fact to stress is the capacity of therapy to produce tumour necrosis both as first-step treatment and as salvage therapy. No conclusions can be drawn in the long-term due to the paucity of controlled and randomized trials with adequate follow-up to establish benefits in terms of global survival and quality of life (balance adversal effects/benefits), lack of comparisons with standard options as long as different definitions of free-survival disease.
Lledó García
E
E
Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid.
Jara Rascón
J
J
Subirá Rós
D
D
Herranz Amo
F
F
Martínez-Salamanca
J I
JI
Hernández Fernández
C
C
D000230:Adenocarcinoma / Q000191:economics / Q000628:therapy*; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000191:economics / Q000628:therapy*; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000191:economics*
D017430:Prostate-Specific Antigen