Background: Prostate cancer is the most common malignant tumor among men and ranks second in cancer-related mortality worldwide. Standard treatment approaches include active surveillance, prostatectomy, and external beam radiation therapy. However, these methods are associated with a high risk of complications. This has led to growing interest in minimally invasive techniques, with high-intensity focused ultrasound (HIFU) gaining particular attention. Despite existing data confirming satisfactory oncological outcomes, questions remain regarding the comparability of this method with traditional approaches. Therefore, it is relevant to analyze the long-term oncological outcomes of prostate cancer treatment using HIFU compared to radical prostatectomy (RP). This study aims to assess the long-term effectiveness of HIFU therapy.

Keywords: prostate cancer, HIFU, radical prostatectomy.

Methods: A retrospective comparative analysis was conducted on data from 190 patients treated with HIFU and 145 patients who underwent RP between 2008 and 2009. The oncological effectiveness of both methods was assessed based on overall survival, cancer-specific survival, and biochemical recurrence-free survival rates. Biochemical recurrence was diagnosed according to ASTRO/Phoenix criteria. Statistical methods included the log-rank test and Kaplan-Meier analysis.

Results: The mean follow-up duration for patients after RP and HIFU was 14.4 and 15.8 years, respectively. The 15-year overall, cancer-specific, and biochemical recurrence-free survival rates were 30.3% / 78.2% / 52,0% in the RP group and 45.5% / 81.3% / 67.8% in the HIFU group. Prognostic factors included pre-treatment PSA levels and Gleason score. The HIFU group showed higher overall survival, while cancer-specific and recurrence-free survival rates were comparable to those in the RP group.

Conclusion: HIFU therapy can be considered as an alternative method of treating prostate cancer in patients with low and intermediate risk of progression according to the D'Amico classification. For high-risk patients, the possibility of repeat HIFU sessions and/or additional adjuvant therapy should be considered. Over long-term follow-up, HIFU demonstrates oncological outcomes comparable to RP, making it a promising treatment option for this pathology.