Assessment of high intensity focused ultrasound for the treatment of prostate cancer.
The optimal treatment for localized prostate tumours remains unknown. The standard curative options (radical prostatectomy and radiotherapy) are not free of significant complications and risks. High-intensity focused ultrasound (HIFU) appears to be an alternative. It is currently used as primary treatment for patients with localized prostate cancer T(1-2) N(0-x) M0, mostly low and intermediate risk, not suitable for surgery and as salvage treatment for locally proven recurrence of prostate cancer after curative therapy. In Belgium, it is estimated that about 730 patients (0.8% of all new prostate cancer patients) were treated with this new technology at 4 hospitals in the years 2000 to 2008. Given the increasing use of HIFU, this study was conducted to assess the current evidence supporting the effectiveness and safety of HIFU and to examine its role in the management of prostate cancer. A standard literature review showed that there is currently not sufficient evidence to support routine use of this new treatment modality. In order to obtain FDA approval, two multicentric non-randomized controlled trials comparing HIFU with cryotherapy and brachytherapy have been started in the U.S. and are now recruiting patients. Until more evidence becomes available, KCE recommends to limit the use of HIFU treatment to study setting. Future research is recommended in the form of comparative studies, preferably randomized controlled trials.
Obyn
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C
Federaal Kenniscentrum voor de Gezondheidszorg (KCE), Brussel. caroline.obyn@kce.fgov.be
Mambourg
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F
D001918:Brachytherapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects