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Prostatic needle biopsies following primary high intensity focused ultrasound (HIFU) therapy for prostatic adenocarcinoma: histopathological features in tumour and non-tumour tissue
  1. Paul Ryan1,2,
  2. Antonio Finelli3,
  3. Nathan Lawrentschuk3,
  4. Neil Fleshner3,
  5. Joan Sweet4,
  6. Carol Cheung4,
  7. Theodorus van der Kwast4,
  8. Andrew Evans4
  1. 1Department of Pathology, Bon Secours Hospital, Cork, Ireland
  2. 2Department of Pathology, Mount Sinai Hospital, Toronto, Canada
  3. 3Department of Urology, University Health Network, Toronto, Canada
  4. 4Department of Pathology, University Health Network, Toronto, Canada
  1. Correspondence to Dr Andrew Evans, University Health Network, Laboratory Medicine Program, Toronto General Hospital, Eaton 11-444, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; andrew.evans{at}


Aims High intensity focused ultrasound (HIFU) is currently offered as primary treatment for patients with clinically localised prostate cancer. Data on histopathological features of post-treatment biopsies are limited.

Methods Pretreatment biopsies were identified in 45 men (age range 41–85) who received primary HIFU therapy. Post-HIFU biopsies were performed in 30 of these patients (67%) at mean 14.1 months (95% CI 11.7 to 16.5) follow-up, 22 due to rising PSA and eight as part of routine follow-up. Biopsies were examined for presence, distribution and extent of adenocarcinoma, Gleason scores, use of standard immunohistochemistry and ablative tissue changes were attributable to HIFU.

Results In post-HIFU biopsies performed for biochemical failure, 17/22 (77%) contained adenocarcinoma; 4/22 (18%) had higher post-HIFU Gleason score; 3/22 (14%) had newly recognised bilateral involvement; and 4/22 (18%) had higher percentage tissue involvement compared with pre-HIFU biopsies. Of cases without rising post-HIFU PSA, 2/8 (25%) routine follow-up biopsies contained adenocarcinoma. Stromal fibrosis was the commonest finding in non-tumour post-HIFU biopsy tissue (17/30, 57%) with coagulative necrosis occurring in fewer cases (4/30, 13%) and over a shorter follow-up interval than cases showing fibrosis (8.5 (0.2–16.8) vs 15.3 (11.5–19.1) months). Treatment effects in tumour cells precluding the assignment of Gleason scores or use of immunohistochemistry in post-HIFU biopsies were not identified.

Conclusion Post-HIFU biopsies are positive in more than 75% of patients with elevated or rising PSA. Stromal fibrosis is common but the tissue effects of this modality do not appear to impair pathologists' ability to detect and grade adenocarcinoma in follow-up biopsies.

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  • Competing interests None declared.

  • Ethics approval The ethics approval was provided by University Health Network Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The study protocol and dataset used for the analysis will be available for use by other investigators, on request and subject to the approval of the authors, for a period not <12 months postpublication (online or in print).