What are the documented risks relating to hifu treatment of the prostate cancer with a 4+3 geelong score

The short version: the retrieved studies barely address Gleason 4+3 at all, and the treatment has a real, documented complication profile that you should weigh carefully.

The studies in this retrieval are dated, small, and mostly don't report outcomes by Gleason score. Only one gives a Grade Group breakdown that overlaps with 4+3 (Grade Group 3): in the 2025 cohort, HIFU patients were mostly intermediate or lower risk, and HIFU had a median follow-up of just 8 months [4]. High-risk disease (which 4+3 borders on) showed an 87.5% biochemical failure rate, but that was 7 or 8 patients [1][2]. That is too few to trust.

The complications are more concrete. In one 74-patient series, 90% reported impotence [1]. Biopsy-confirmed residual cancer appeared in about 15.5% [1]. Rectovesical fistula occurred once [1]. A 250-patient series reported 6% recto-urethral fistula, 7% severe incontinence, and 17% bladder neck stenosis [2]. Another found 24.6% urethral stricture with HIFU alone [3]. Focal therapy overall requires further treatment in roughly 10-30% of men [5]. Whether 4+3 specifically drives higher failure than lower grades is not answered here.

General background, outside this retrieval: Grade Group 3 (4+3) is intermediate-unfavorable, and oncologic durability matters more there than in low-risk disease. The 2025 cohort found superior long-term cancer control with surgery over HIFU, though follow-up was short for HIFU [4].

My call: for a 4+3 tumor, the complications are well documented and the cancer-control data at that grade is thin. Confidence: low on Gleason-specific risk, moderate on the complication rates.