Magnetic Resonance Imaging and Targeted Biopsies Compared to Transperineal Mapping Biopsies Before Focal Ablation in Localised and Metastatic Recurrent Prostate Cancer After Radiotherapy

Shah, Taimur T.; Kanthabalan, Abi; Otieno, Marjorie; Pavlou, Menelaos; Omar, Rumana; Adeleke, Sola; Giganti, Francesco; Brew‐Graves, Chris; Williams, Norman; Grierson, Jack; Miah, Haroon; Emara, Amr; Haroon, Athar; Latifoltojar, Arash; Sidhu, Harbir; Clemente, Joey; Freeman, Alex; Orczyk, Clément; Nikapota, A.; Dudderidge, Tim; Hindley, Richard G.; Virdi, Jaspal; Arya, Manit; Payne, Heather; Mitra, Anita; Bomanji, Jamshed; Winkler, Mathias; Horan, Gail; Moore, Caroline M.; Emberton, Mark; Punwani, Shonit; Ahmed, Hashim U.

doi:10.1016/j.eururo.2022.02.022

Cited by 13 publications

(13 citation statements)

References 19 publications

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“…Unlike the treatment of biochemical recurrence post radical prostatectomy (RP), treatment of locally recurrent PCa after definitive radiotherapy is controversial. Treatment options include salvage RP, repeat radiotherapy or whole gland/focal ablation [5][6][7]. However, all local salvage options carry high rates of severe genitourinary and gastrointestinal side effects.…”

Section: Introductionmentioning

confidence: 99%

Salvage irreversible electroporation for radio‐recurrent prostate cancer – the prospective FIRE trial

et al. 2023

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Objectives To prospectively assess the safety, functional‐ and oncological‐outcomes of irreversible electroporation (IRE) as salvage therapy for radio‐recurrent focal prostate cancer in a multicenter setting. Patients and methods Men with focal recurrent PCa after external beam radiation or brachytherapy without metastatic disease on staging imaging and co‐registration between mpMRI and biopsies were prospectively included in this multicenter trial. Adverse events were reported following the Clavien‐Dindo classification. Validated questionnaires were used for patient‐reported functional outcomes. Follow‐up consisted of 3 monthly prostate specific antigen (PSA) levels, a 6‐month mpMRI and standardised transperineal template mapping biopsies at 12‐months. Thereafter follow‐up was guided by MRI and/or PSMA‐PET/CT and PSA. Local recurrence was defined as any ISUP score ≥2 on biopsies. Results 37 patients were analysed with a median (interquartile range (IQR)) follow up of 29 (22–43) months. Median age was 71 (53–83), median PSA was 3.5 ng/mL (2.7–6.1). 28 (75.5%) patients harboured intermediate risk and 9 patients (24.5%) high risk PCa. Seven patients (19%) reported self‐limiting urgency, frequency, or hematuria (grade 1–2). Seven patients (19%) developed a grade 3 AE; urethral sludge requiring transurethral resection. At 12 months post treatment 93% of patients remained continent and erectile function sufficient for intercourse deteriorated from 35% to 15% (4/27). Local control was achieved in 29 patients (78%) and 27 patients (73%) were clear of local and systemic disease. Four (11%) patients had local recurrence only. Six (16%) patients developed metastatic disease with a median time to metastasis of 8 months. Conclusion The FIRE trial shows that salvage IRE after failed radiation therapy for localised PCa is safe with minimal toxicity, and promising functional and oncological outcomes. Salvage IRE can offer a possible solution for notoriously difficult to manage radio recurrent prostate tumours.

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Section: Introductionmentioning

confidence: 99%

Salvage irreversible electroporation for radio‐recurrent prostate cancer – the prospective FIRE trial

et al. 2023

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“…This may be due to a higher proportion of the external validation HIFU‐treated cohort having undergone previous brachytherapy compared to the development cohort (difference 11% [13% vs 3%], Fisher's exact test P < 0.001). The presence of brachytherapy seeds, typically, is a relative indication to treat with cryotherapy over HIFU [6]. Nonetheless, despite being developed in an exclusively HIFU‐treated cohort, it is encouraging to see good model calibration for cryotherapy‐treated patients in this validation.…”

Section: Discussionmentioning

confidence: 99%

“…Wider application of salvage focal treatments will require optimisation of two key areas: (i) accurate diagnosis and localisation of radiorecurrent disease; and (ii) patient selection for salvage treatment. FORECAST addressed the former, showing that radiorecurrent cancer is prevalent in those with a rising PSA (80%), and that mpMRI followed by both systematic and targeted biopsies is important for detecting this [6]. The model by Peters et al.…”

Section: Discussionmentioning

confidence: 99%

External validation of a risk model predicting failure of salvage focal ablation for prostate cancer

et al. 2023

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ObjectivesTo externally validate a published model predicting failure within 2 years after salvage focal ablation in men with localised radiorecurrent prostate cancer using a prospective, UK multicentre dataset.Patients and methodsPatients with biopsy‐confirmed ≤T3bN0M0 cancer after previous external beam radiotherapy or brachytherapy were included from the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial (NCT01883128; 2014–2018; six centres), and from the high‐intensity focussed ultrasound (HIFU) Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) UK‐based registries (2006–2022; nine centres). Eligible patients underwent either salvage focal HIFU or cryotherapy, with the choice based predominantly on anatomical factors. Per the original multivariable Cox regression model, the predicted outcome was a composite failure outcome. Model performance was assessed at 2 years post‐salvage with discrimination (concordance index [C‐index]), calibration (calibration curve and slope), and decision curve analysis. For the latter, two clinically‐reasonable risk threshold ranges of 0.14–0.52 and 0.26–0.36 were considered, corresponding to previously published pooled 2‐year recurrence‐free survival rates for salvage local treatments.ResultsA total of 168 patients were included, of whom 84/168 (50%) experienced the primary outcome in all follow‐ups, and 72/168 (43%) within 2 years. The C‐index was 0.65 (95% confidence interval 0.58–0.71). On graphical inspection, there was close agreement between predicted and observed failure. The calibration slope was 1.01. In decision curve analysis, there was incremental net benefit vs a ‘treat all’ strategy at risk thresholds of ≥0.23. The net benefit was therefore higher across the majority of the 0.14–0.52 risk threshold range, and all of the 0.26–0.36 range.ConclusionIn external validation using prospective, multicentre data, this model demonstrated modest discrimination but good calibration and clinical utility for predicting failure of salvage focal ablation within 2 years. This model could be reasonably used to improve selection of appropriate treatment candidates for salvage focal ablation, and its use should be considered when discussing salvage options with patients. Further validation in larger, international cohorts with longer follow‐up is recommended.

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“…We hypothesised higher LCC scores, reflecting increased neutrophil activity, may correspond with the presence and degree of radiorecurrence. Participants were part of the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) prospective paired‐cohort study (NCT01883128) [6]. Between 2014 and 2018, 181 patients were enrolled from six UK centres with biochemical failure after EBRT or brachytherapy with/without (neo)adjuvant androgen‐deprivation therapy (ADT).…”

Section: Figmentioning

confidence: 99%

The ‘Leucocyte Coping Capacity’ test for identifying radiorecurrent prostate cancer: a pilot study

et al. 2023

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Magnetic Resonance Imaging and Targeted Biopsies Compared to Transperineal Mapping Biopsies Before Focal Ablation in Localised and Metastatic Recurrent Prostate Cancer After Radiotherapy

Cited by 13 publications

References 19 publications

Salvage irreversible electroporation for radio‐recurrent prostate cancer – the prospective FIRE trial

Salvage irreversible electroporation for radio‐recurrent prostate cancer – the prospective FIRE trial

External validation of a risk model predicting failure of salvage focal ablation for prostate cancer

The ‘Leucocyte Coping Capacity’ test for identifying radiorecurrent prostate cancer: a pilot study

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