Actas Urológicas Españolas
versión impresa ISSN 0210-4806
LLEDO GARCIA, E. et al. Scientific evidence on the use of high-intensity focal ultrasound (HIFU) in the treatment of prostatic carcinoma. Actas Urol Esp [online]. 2005, vol.29, n.2, pp.131-137. ISSN 0210-4806.
Objectives: To evaluate in the literature scientific evidence on the use of High-Intensity Focal Ultrasound (HIFU) in the treatment of prostatic carcinoma (PC). Method: Three database are searched: PubMed, Cochrane Library, HTA database. Several articles were selected taking into account number of cases, inclusion criteria, duration of follow-up period. We have evaluated the best evidence available thorugh a systematic review of clinical efficacy and cost-effectiveness of HIFU in the treatment of PC. We analized global survival, diseasefree survival, and quality of life, including complications, adversal effects and acceptance of the technique. Results: Publications available are focused on two main indications of the therapy: first step of management of PC and salvage therapy for locally recurrent PC after external beam radiotherapy. It was very difficult to draw conclusions on the relative benefits of the HIFU: lack of high or medium quality evidence and no comparisons between this technique an standard treatments. In relation to results on cost-effectiveness, no relevant studies were identified in order to get conclusions on the quality of the treatment. Most of reports offered disparity in the definition of free survival disease concept. This fact produce some misunderstanting of results and conclusions cannot be drawn correctly. Inclusion criteria were also heterogeneous between authors. Conclusions: No high-quality clinical evidence can be established currently on the utility of HIFU as treatment of prostatic cancer. An important fact to stress is the capacity of therapy to produce tumour necrosis both as first-step treatment and as salvage therapy. No conclusions can be drawn in the long-term due to the paucity of controlled and randomized trials with adequate follow-up to establish benefits in terms of global survival and quality of life (balance adversal effects/benefits), lack of comparisons with standard options as long as different definitions of free-survival disease.
Palabras clave : Prostate cancer; HIFU; Minimally invasive treatments.