High-intensity focused ultrasound for the treatment of prostate cancer: a national cohort study focusing on the development of stricture and fistulae

Background: High-intensity focused ultrasound (HIFU) is a novel therapy for prostate cancer. Owing to a lack of long-term data, HIFU is recommended for use only in the context of research.

Objective: To examine the trend for HIFU use nationally and rates of strictures and fistulae.

Design, setting, and participants: Patients undergoing HIFU for prostate cancer between April 2007 and March 2018 were studied in an English national database (Hospital Episode Statistics). Data on complications were included for patients with a minimum of 1-yr follow-up. Analysis of complications was controlled for other interventions.

Outcome measures and statistical analysis: Descriptive analyses of HIFU rates and the incidence of strictures and fistulae were carried out. Cox and logistic regression models were built for urethral stricture incidence.

Results and limitations: A total of 2320 HIFU treatments among 1990 patients were identified. The median age was 67 yr (interquartile range 61–72). Some 1742 patients met the criteria for follow-up analysis. The highest-volume centre performed 1513 HIFU procedures, followed by 194 at the second highest. The number of HIFU procedures increased annually, rising from 196 to 283 per year. There were 208 patients (11.9%) who went on to have radiotherapy and 102 (5.9%) radical prostatectomy after HIFU. Following HIFU, stricture developed in 133/1290 patients (10.3%) and urinary fistula in 16/1240 (1.3%) before any further intervention. More recent years for HIFU were associated with a lower likelihood of stricture formation (2016/2017 vs 2007/2008: hazard ratio 0.30, 95% confidence interval 0.11–0.79; p = 0.015). Limitations include the lack of staging information and unknown rates of HIFU outside of publicly funded health care.

Conclusions: HIFU is performed at a large number of low-volume centres and complication rates do not differ from those for established therapies.

Patient summary: This report highlights the trend for provision of high-intensity focused ultrasound treatment for prostate cancer in England. The results suggest that the rate of urethral structural complications may not be lower than that for established prostate cancer treatments.