Anxiety and Health-related Quality of Life in Men with Prostate Cancer Undergoing Focal Therapy: A Prospective Single-arm Phase 2 Trial

Thomas Paul Scherer; Anna Gugerli Lazos; Julian Sonderer; Basil Kaufmann; Florian Alexander Schmid; Josef Jenewein; Niels J Rupp; Holger Moch; Daniel Eberli; Ashkan Mortezavi

doi:10.1016/j.euf.2025.08.006

Anxiety and Health-related Quality of Life in Men with Prostate Cancer Undergoing Focal Therapy: A Prospective Single-arm Phase 2 Trial

Eur Urol Focus. 2025 Sep 9:S2405-4569(25)00253-6. doi: 10.1016/j.euf.2025.08.006. Online ahead of print.

Affiliations

¹ Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland. Electronic address: thomas.scherer@usz.ch.
² Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
³ Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Urologie Appenzellerland, Appenzell, Switzerland.
⁴ Privatklinik Hohenegg, Zürich, Switzerland.
⁵ Department of Pathology and Molecular Pathology, University Hospital of Zürich, Zürich, Switzerland.

PMID: 40930919
DOI: 10.1016/j.euf.2025.08.006

Abstract

Background and objective: While whole-gland therapies for localized prostate cancer (PCa) offer excellent oncological outcomes, these can impact patients' quality of life (QoL) through serious side effects. Focal therapy using high-intensity focused ultrasound (HIFU) has emerged as a less invasive alternative to preserve QoL. However, data on the psychological impact of HIFU remain rare. This prospective study evaluates health-related QoL and emotional burden over 36 mo in men undergoing focal HIFU.

Methods: In this prospective, single-arm, phase 2 trial (NCT02265159), 91 men with localized PCa (International Society of Urological Pathology grade group ≤3 and prostate-specific antigen ≤15 ng/ml) were treated with focal HIFU. Psychological distress and QoL were assessed at baseline and 6, 12, and 36 mo after HIFU using the following questionnaires: Memorial Anxiety Scale for Prostate Cancer (MAX-PC; PCa-specific anxiety), Hospital Anxiety and Depression Scale (HADS; anxiety and depression), and Functional Assessment of Cancer Therapy-Prostate (FACT-P; health-related QoL). Clinically significant distress was determined using established cutoffs.

Key findings and limitations: The psychological burden was generally low throughout the study period. MAX-PC scores declined steadily over time. HADS anxiety and depression scores displayed a transient increase at 6 and 12 mo, but returned to baseline at 36 mo. At all time points, <3% of patients had scores above the threshold for clinically significant distress on the MAX-PC and HADS questionnaires. FACT-P scores remained stable and high, with no significant score changes in the total health-related QoL.

Conclusions and clinical implications: Focal HIFU treatment for localized PCa is associated with a low psychological burden and stable, high health-related QoL. These results demonstrate the enduring impact of this organ-sparing approach on both psychological and QoL outcomes.

Keywords: Focal therapy; High-intensity focused ultrasound ablation; Image-guided surgery; Patient-related outcomes measures; Prostate cancer; Quality of life.