Focal High-Intensity Focused Ultrasound (HIFU) has emerged as a viable treatment for localized prostate cancer, offering acceptable local disease control while minimizing morbidity. However, recurrences remain a common challenge, prompting the need to identify pre-treatment factors that could predict persistent cancer one year after treatment. In this study, we analyzed a cohort of 144 patients who underwent focal HIFU at a single institution between 2016 and 2022. After excluding 15 patients who had received prior radiation, androgen deprivation therapy (ADT), or previous HIFU treatments, as well as 52 individuals without available one-year biopsy results, we focused on 77 patients. Treatment failure was defined as ISUP Grade Group≥2 on the 12-month biopsy, which was obtained through repeat MRI, targeted biopsy of suspicious lesions (PIRADS v2.1≥3), and systematic biopsy.
At the one-year follow-up, 18% of the treated subjects were found to have ISUP Grade Group≥2 cancer. A total of 16 covariates were analyzed to determine their association with treatment failure. Our analysis revealed that lesion location was the only significant predictor of treatment failure; specifically, involvement of the prostate base significantly increased the risk of failure (odds ratio [OR] = 3.55, p = 0.046, AUC = 0.63). In contrast, lesions located in the mid-gland were associated with a decreased risk of treatment failure (OR = 0.22, p = 0.016, AUC = 0.68), and peripheral zone lesions were less likely to fail compared to central gland lesions (OR = 0.22, p = 0.042, AUC = 0.60). These findings suggest that urologists should carefully consider lesion location when selecting patients for focal HIFU to optimize treatment outcomes.
