Excessive pre-HIFU PSA ranges in intermediate-risk prostate most cancers have been linked to elevated recurrence and remedy failure, per ASCO 2025 analysis.
Amongst sufferers with intermediate-risk prostate most cancers, excessive prostate-specific antigen (PSA) ranges earlier than remedy with a Excessive-Depth Targeted Ultrasound (HIFU) had a hyperlink to an elevated danger of general recurrence and remedy failure, in response to analysis revealed in a poster on the 2025 ASCO Genitourinary Cancers Symposium.
On this investigation of 108 males with intermediate-risk prostate most cancers following HIFU, investigators discovered that in-field and general recurrence on 1-year biopsy was 41% and 54%, respectively. Furthermore, Gleason grade (GG) 3 or increased was related to each in-field and general recurrence on biopsy, whereas sexual and urinary perform scores didn’t differ earlier than vs after HIFU.
“Increased pre-HIFU PSA was related to remedy failure and general recurrence on biopsy, and GG3 [or higher] was related to in-field and general recurrence on biopsy, first research writer Dr. Kevin Shee, and authors wrote within the summary of the research.
Shee at present works within the Division of Urology, College of California, San Francisco (UCSF), UCSF Well being, and is a Resident of Urology on the UCSF College of Drugs.
Glossary:
Gleason Grade: a quantity that describes how irregular prostate most cancers cells seem underneath a microscope.
Excessive-Depth Targeted Ultrasound (HIFU): a non-invasive process that makes use of ultrasound waves to destroy irregular tissue.
Prostate-specific antigen (PSA): protein within the blood that may point out prostate most cancers.
Breaking Down the Strategies of the Analysis
Definitive remedy and lively surveillance are each widespread methods to handle intermediate-risk prostate most cancers. Though definitive remedies, resembling radical prostatectomy or radiation remedy, are efficient, they’re typically related to important uncomfortable side effects. For sufferers with favorable-risk illness, lively surveillance could also be an choice, however this method carries the chance of most cancers development over time.
Focal therapies selectively ablate cancerous tissue whereas minimizing the influence on high quality of life, offering a extra balanced method. One such remedy is Excessive-Depth Targeted Ultrasound (HIFU), which makes use of magnetic resonance imaging (MRI) and ultrasound to ship high-frequency acoustic power. Regardless of the potential advantages of HIFU, issues concerning illness recurrence and development to salvage remedy have restricted its widespread adoption. To handle investigators investigated pre-treatment traits related to remedy development and biopsy-confirmed recurrence following HIFU.
In investigation, male sufferers have been eligible for enrollment if they’d biopsy-confirmed intermediate-risk prostate most cancers, had undergone HIFU at UCSF Well being between 2021 and 2023, and had a one-year post-treatment biopsy. Eligible individuals obtained a single ablative remedy utilizing FocalOne HIFU, with ablation contours designed to take care of a 10mm margin across the tumor whereas sparing the nerves and urethra.
Key outcomes of curiosity included biopsy-confirmed recurrence, remedy failure requiring salvage remedy or indicating metastatic development, and modifications in urinary and sexual perform.
A complete of 108 males with a median age of 65 years have been enrolled on the research. The median prostate quantity of these enrolled was 36 cc’s, the median PSA was 6.1 ng/ML and the median yr of prognosis was 2021 . A majority of sufferers enrolled have been White, (82%), although different races and ethnicities included have been Asian/Pacific Islander (5%), African American (5%), and Combined (8%).
Scientific T-stage of sufferers ranged from T1 (32%) to T2 (65%) and T3 (3%), whereas some have been lacking. The pre-HIFU GG have been GG2 (73%), GG3 (22%), and GG4-5 (5%). Moreover, sufferers’ major remedies have been HIFU (56%) or lively surveillance (44%).
Delving Into Additional Findings
In Mannequin 1, which evaluated steady PSA, for biopsy-proven general recurrence, GG grade (GG3+ versus GG2) was related to increased recurrence danger, as have been PSA ranges. In Mannequin 2, which categorized PSA ranges, a PSA degree larger than 10 ng/mL versus lower than 6 ng/mL was additionally related to elevated recurrence danger.
For biopsy-proven in-field recurrence, GG remained a major think about each fashions. Concerning remedy failure, PSA ranges remained a predictor. In Mannequin 1, increased PSA ranges have been related to an elevated danger of remedy failure. In Mannequin 2, which was the explicit PSA mannequin, PSA ranges larger than 10 ng/mL versus lower than 6 ng/mL have been additionally linked to remedy failure.
Shee and research authors conclude the research’s summary by stating: “These findings emphasize the significance of cautious affected person choice for HIFU, which has potential for modest most cancers management with minimal uncomfortable side effects within the applicable [patient with] intermediate-risk prostate most cancers.”
Reference:
“Figuring out optimum affected person choice for high-intensity targeted ultrasound (HIFU) for prostate most cancers: Outcomes from a single-institution cohort” by Dr. Kevin Shee et al., Journal of Scientific Oncology.
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