**9. Long-term results of HIFU treatment**

Many authors have reported their series after HIFU treatment.

One of the most recent is the multicentric study carried out by Crouzet et al16, who reported a series of 803 patients with a mean follow-up of 43 months. The results of this study are excellent, showing that local control and disease-free survival rate achieved with HIFU were similar to those expected with conformal external-beam radiation therapy (EBRT).

The excellent cancer-specific survival rate reported in this study is also explained by the possibility to repeat HIFU and use salvage EBRT.

The first UK series was reported by Ahmed et al and published on the British Journal of Cancer. 172 men were treated with HIFU with excellent result: 92.4% of patients had no recurrence after a mean follow-up of 346 days17.

Blana et al published a series of 140 men treated with HIFU, reporting good oncological outcome in long-term follow-up (6.4 years), demonstrating the effective long-term cancer control achieved with HIFU in patients with low- or intermediate-risk localised prostate cancer18.

Finally, it is correct to cite the negative results reported by Challacombe et al, who interrupted the treatment because of the poor oncological outcome19.

From all the studies presented, there is clear evidence that the treatment could affect prostate cancer, as shown by both a substantial decrease in serum PSA and negative biopsies after therapy there is clear evidence that the treatment could affect prostate cancer.

The effect has also been demonstrated on radical prostatectomy specimens examined 2 weeks after HIFU.

Fig. 9. HSP-70 expression in prostate tissue after HIFU treatment in a case of recurrence

One of the most recent is the multicentric study carried out by Crouzet et al16, who reported a series of 803 patients with a mean follow-up of 43 months. The results of this study are excellent, showing that local control and disease-free survival rate achieved with HIFU were

The excellent cancer-specific survival rate reported in this study is also explained by the

The first UK series was reported by Ahmed et al and published on the British Journal of Cancer. 172 men were treated with HIFU with excellent result: 92.4% of patients had no

Blana et al published a series of 140 men treated with HIFU, reporting good oncological outcome in long-term follow-up (6.4 years), demonstrating the effective long-term cancer control achieved with HIFU in patients with low- or intermediate-risk localised prostate

Finally, it is correct to cite the negative results reported by Challacombe et al, who

From all the studies presented, there is clear evidence that the treatment could affect prostate cancer, as shown by both a substantial decrease in serum PSA and negative biopsies after therapy there is clear evidence that the treatment could affect prostate cancer. The effect has also been demonstrated on radical prostatectomy specimens examined 2

similar to those expected with conformal external-beam radiation therapy (EBRT).

**9. Long-term results of HIFU treatment** 

possibility to repeat HIFU and use salvage EBRT.

recurrence after a mean follow-up of 346 days17.

cancer18.

weeks after HIFU.

Many authors have reported their series after HIFU treatment.

interrupted the treatment because of the poor oncological outcome19.

There are no randomized controlled studies available to compare the outcome of these therapies with each other, other therapies, or watchful waiting.

The combination of a TURP performed just before an HIFU seems to reduce the complications but without affecting the oncologic outcome negatively.

As of today, it is not possible to compare the outcome of HIFU with other treatment modalities for localized prostate cancer.
