Morbidity Associated with Primary High Intensity Focused Ultrasound and Redo High Intensity Focused Ultrasound for Localized Prostate Cancer

Abstract

High intensity focused ultrasound may have a role as an alternative to standard radical therapies for localized prostate cancer. An attribute of high intensity focused ultrasound is that it can be repeated. We determined morbidity after primary and redo high intensity focused ultrasound. We performed an academic lead analysis of United Kingdom registry data on high intensity focused ultrasound treatments at 3 centers using patient reported continence and sexual function outcomes. Validated questionnaires were completed before and after each ultrasound treatment. A total of 359 patients received 1 whole gland high intensity focused ultrasound treatment for localized prostate cancer from October 2004 to June 2012, of whom 130 (36.2%) received re-treatment. Median followup was 27 months (range 3 to 81) after re-treatment. When analyzing adverse events, 10.8% of patients experienced urinary tract infection after the first treatment compared to 3.9% after re-treatment (p=0.009). Urethral dilatation was required in 13.8% and 14.0% of patients after first and redo ultrasound treatments (p=0.7), and bladder neck incision was required in 9.2% and 11.6%, respectively (p=0.2). Before and after re-treatment 73.3% and 55.1% of patients had no leak, and 2.7% and 9.0% used daily pads (p<0.001 and p=0.07, respectively). Analysis of erectile function showed that 56.2% and 56.0% of patients were potent before and after re-treatment, respectively (p=0.9). Redo high intensity focused ultrasound is associated with an increase in urinary side effects but sexual side effects do not appear to be significantly increased. The number of adverse events seems to be equivalent after first and redo treatments. Meticulous patient selection is of paramount importance when selecting men for redo high intensity focused ultrasound.