The feasibility and safety of high‐intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy

Abstract

OBJECTIVES To investigate the use of minimally invasive high‐intensity focused ultrasound (HIFU) as a salvage therapy in men with localized prostate cancer recurrence following external beam radiotherapy (EBRT). PATIENTS AND METHODS A review of 31 cases treated using the Sonablate® 500 HIFU device, between 1 February 2005 and 15 May 2007, was carried out. All men had presumed organ‐confined, histologically confirmed recurrent prostate adenocarcinoma following EBRT. RESULTS The mean (range) age was 65 (57–80) years with a mean preoperative PSA level of 7.73 (0.20–20) ng/mL. The patients were followed for a mean (range) of 7.4 (3–24) months. Side‐effects included stricture or intervention for necrotic tissue in 11 of the 31 patients (36%), urinary tract infection or dysuria syndrome in eight (26%), and urinary incontinence in two (7%). Recto‐urethral fistula occurred in two men, although one was due to patient movement due to inadequate anaesthesia, so the ‘true’ rate is 3%. Half of the patients had PSA levels of <0.2 ng/mL at the last follow‐up. Three patients had metastatic disease whilst another two had only local, histologically confirmed, failure. A further four patients had evidence of biochemical failure only. Overall, 71% had no evidence of disease following salvage HIFU. CONCLUSIONS Salvage HIFU is a minimally invasive daycase procedure that can achieve low PSA nadirs and good cancer control in the short term, with comparable morbidity to other forms of salvage treatment. The issue of accurate staging at the time of recurrence is still problematic, as a proportion of these men will harbour microscopic metastases undetected by conventional staging investigations.

Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy

“…Our results suggest that DCE may be easy for radiologists to interpret (81.1% agreement), though its relative low PPV (64.9%) suggests that metallic seed distortion may limit its interpretation. It is possible that the discrepancy between our findings and others resulted from a more heterogeneous decrease in prostate vascularization after brachytherapy compared with EBRT, making it more difficult to interpret post-brachytherapy DCE (22).…”

“…Other studies have examined mpMRI efficacy after EBRT (19)(20)(21)(22), and observed DCE to be a valuable sequence. Our results suggest that DCE may be easy for radiologists to interpret (81.1% agreement), though its relative low PPV (64.9%) suggests that metallic seed distortion may limit its interpretation.…”

Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy

“…Furthermore, the rates of genitourinary and pelvic complications appear to be encouragingly low. 8 One of the major challenges in selecting men who are suitable for salvage therapy is accurate staging. It is estimated that up to 50% of men who fail EBRT may have distant metastatic disease.…”

“…The biochemical cancer control rates that result from these salvage therapies are on the order of 40% to 60% over 2 to 5 years follow-up. [6][7][8] We previously reported our early results using focal therapy in men with primary disease. 9 Focal salvage therapy has been proposed as an alternative that may provide treatment for localized, radiorecurrent disease while reducing the impact on functional status.…”

Transrectal high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer: review of technical incidents and morbidity after 5 years of use

“…3 Its advantages are manifold according to the investigator centres: it is minimally invasive, it can be repeated if required and other treatments can be offered in cases of incomplete treatment or recurrence. 4,5 Currently, it is used in patients who are not eligible for surgery or as salvage therapy for local recurrence after radiotherapy. Patients are often informed that the treatment is local and precise, can be repeated, requires a short hospital stay and is associated with few side effects.…”