ArticleFrontiers in urology2026
Comparative outcomes of focal HIFU versus active surveillance in low- and intermediate-risk localized prostate cancer: a 75-month retrospective cohort study.
Article in Frontiers in urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Focal high-intensity focused ultrasound (HIFU) is a minimally invasive treatment for localized prostate cancer. Its comparative effectiveness against active surveillance (AS) remains underexplored in patients eligible for either strategy. Methods: This retrospective cohort study analyzed 635 men with localized prostate cancer treated between 2018 and 2023: 303 received focal HIFU and 332 underwent AS. Only low-risk and favorable intermediate-risk patients per NCCN guidelines were included (PSA <20 ng/mL, stage ≤T2b, ISUP ≤2, <50% positive cores). Multiparametric MRI and targeted biopsies confirmed eligibility. Outcomes included progression to clinically significant prostate cancer (csPC: ISUP ≥3 or ISUP 2 with PIRADS ≥4), radical treatment-free survival, PSA kinetics, and functional outcomes (IPSS, IIEF-5, continence). Results: Baseline characteristics were comparable. At 12 months, csPC-free survival was higher with HIFU in intermediate-risk patients (95.8% vs. 84.0%, p=0.0018) and low-risk patients (97.6% vs. 88.3%, p=0.0035). At a median follow-up of 75 months, HIFU maintained superior csPC-free rates in both risk groups. Radical treatment-free survival was similar in both low and intermediate risk group 76% vs 77.1% and 83.2% vs 80.3% respectively, time to radical treatment was significantly longer in the HIFU group. PSA reductions at 3 and 6 months were greater with HIFU. Functional outcomes, including erectile function, continence, and urinary symptoms, were comparable between groups. Conclusions: Focal HIFU offers better short-term oncological control and delays the need for radical treatment compared to AS, with similar preservation of urinary and sexual function. These results support its use in selected patients seeking a balance between cancer control and quality of life.
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