How do HIFU complication risks change with prostate size and PSA?

The short version: nothing in these records shows complication rates broken down by prostate size or by PSA level. Baseline PSA predicts cancer control, not complications.

The one study that separates failure by PSA-driven risk group found high-risk disease failed 87.5% of the time, intermediate 20%, low 16.6% [1]. That is about the cancer coming back, not about fistulas or impotence. The same series reported impotence in 90% and a rectovesical fistula in one patient, but not by size or PSA [1]. The 2025 comparison reports median prostate volume around 44 cm3 and median PSA around 7 ng/mL in the HIFU group, with 10 total complications, yet it never cross-tabulates complications against either variable [2]. So the honest answer is that these records cannot tell you whether a larger gland or a higher PSA raises your surgical risk.

Mechanistically, a bigger gland means a longer treatment field and more heat near the rectum and bladder neck, and a higher PSA usually means more cancer or a larger gland, but that is inference, not a measured rate. No record here tests it.

My call: on the question you asked, the evidence is not clear. What would settle it is a series reporting fistula, incontinence, and impotence stratified by gland volume and by PSA, and I do not have one. Confidence: low.