{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:00:49Z","timestamp":1780473649482,"version":"3.54.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Urol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Focal high-intensity focused ultrasound (HIFU) is a minimally invasive treatment for localized prostate cancer. Its comparative effectiveness against active surveillance (AS) remains underexplored in patients eligible for either strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study analyzed 635 men with localized prostate cancer treated between 2018 and 2023: 303 received focal HIFU and 332 underwent AS. Only low-risk and favorable intermediate-risk patients per NCCN guidelines were included (PSA &amp;lt;20 ng\/mL, stage \u2264T2b, ISUP \u22642, &amp;lt;50% positive cores). Multiparametric MRI and targeted biopsies confirmed eligibility. Outcomes included progression to clinically significant prostate cancer (csPC: ISUP \u22653 or ISUP 2 with PIRADS \u22654), radical treatment-free survival, PSA kinetics, and functional outcomes (IPSS, IIEF-5, continence).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline characteristics were comparable. At 12 months, csPC-free survival was higher with HIFU in intermediate-risk patients (95.8% vs. 84.0%, p=0.0018) and low-risk patients (97.6% vs. 88.3%, p=0.0035). At a median follow-up of 75 months, HIFU maintained superior csPC-free rates in both risk groups. Radical treatment-free survival was similar in both low and intermediate risk group 76% vs 77.1% and 83.2% vs 80.3% respectively, time to radical treatment was significantly longer in the HIFU group. PSA reductions at 3 and 6 months were greater with HIFU. Functional outcomes, including erectile function, continence, and urinary symptoms, were comparable between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Focal HIFU offers better short-term oncological control and delays the need for radical treatment compared to AS, with similar preservation of urinary and sexual function. These results support its use in selected patients seeking a balance between cancer control and quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fruro.2026.1801127","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:03:36Z","timestamp":1780470216000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative outcomes of focal HIFU versus active surveillance in low- and intermediate-risk localized prostate cancer: a 75-month retrospective cohort study"],"prefix":"10.3389","volume":"6","author":[{"given":"Mohammad","family":"Jaabou","sequence":"first","affiliation":[{"name":"Department of Urology, Hamah National Hospital","place":["Hamah, Syria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Buscarini","sequence":"additional","affiliation":[{"name":"Mount Sinai Hospital","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Zaytoun","sequence":"additional","affiliation":[{"name":"Mount Sinai Hospital","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Dovey","sequence":"additional","affiliation":[{"name":"Mount Sinai Hospital","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke","family":"Hildebrand","sequence":"additional","affiliation":[{"name":"St. George\u2019s University","place":["St. George\u2019s, Grenada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Modassar","family":"Awan","sequence":"additional","affiliation":[{"name":"Mount Sinai Hospital","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maida","family":"Bada","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Sagrada Familia","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Al Ogaili","sequence":"additional","affiliation":[{"name":"St. George\u2019s University","place":["St. George\u2019s, Grenada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Rabie","sequence":"additional","affiliation":[{"name":"Northwell Health","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2014.73","article-title":"Management of low risk prostate cancer\u2014active surveillance and focal therapy","volume":"11","author":"Klotz","year":"2014","journal-title":"Nat Rev Clin Oncol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.eururo.2021.08.005","article-title":"An updated systematic review on focal therapy in localized prostate cancer: what has changed over the past 5 years","volume":"81","author":"Hopstaken","year":"2022","journal-title":"Eur Urol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41391-023-00702-1","article-title":"The state of focal therapy in the treatment of prostate cancer: the University of California Collaborative (UC-Squared) consensus statement","volume":"27","author":"Javier-DesLoges","year":"2024","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2017.11.095","article-title":"Clinically localized prostate cancer: AUA\/ASTRO\/SUO guideline. 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