High-Intensity Focused Ultrasound Versus Robot-Assisted Radical Prostatectomy for Localized Prostate Cancer: A Systematic Review and Meta-Analysis of Oncologic and Functional Outcomes

This study aimed to compare functional and oncologic outcomes between high-intensity focused ultrasound (HIFU) and robot-assisted radical prostatectomy (RARP) for patients with localized prostate cancer (LPCa).

Four databases (Embase, PubMed, Cochrane Library, Web of Science) were systematically searched from inception to December 2025. The review followed PRISMA 2020 and AMSTAR 2 guidelines. Pooled effect estimates were calculated using Stata 17. Random-effects models were applied when I² was 50 % or higher or the P value was lower than 0.10.

Five cohort studies (n = 2123) were included. In this review, HIFU was associated with significantly higher International Index of Etile Function (IIEF)-5 scores at 6 months (effect, 3.41; 95 % confidence interval [Cl], 1.88–4.94; P < 0.05), 12 months (effect, 3.75; 95% Cl 3.00–4.49; P < 0.05), and 24 months (effect, 2.72; 95% Cl 0.59–4.85; P < 0.05). Urinary continence overy also favored HIFU (odds ratio [OR], 0.40; 95% Cl 0.27–0.59; P < 0.05) for pad-free rates at baseline and at 6 and 12 months (all P < 0.05). No significant differences were observed in International Prostate Symptom Score (IPSS) or salvage therapy rates.

For patients with localized prostate cancer, HIFU offers better etile function and urinary continence overy than RARP, with comparable complication and salvage therapy rates. Long-term oncologic outcomes remain to be confirmed.