e298 Background: Prostate cancer is commonly managed with radical prostatectomy (RP) or radiation therapy (RT). 20-40% of men undergoing RP experience biochemical recurrence (BCR) before 10 years. 30-50% or those receiving RT experience BCR. Treatment options for these men are limited and include: salvage radiation, close surveillance, androgen deprivation therapy (ADT), or participation in a clinical trial. Our IRB-approved study evaluated the use of transrectally delivered, MR-guided laser focal therapy with real-time MR thermometry for the treatment of recurrent prostate cancer. Methods: 63 y.o. patient treated September, 2014 with MR-guided laser focal salvage therapy for locally recurrent prostate cancer, Gleason score 4+5 involving the transition zone far anteriorly at the base level measuring 1.4 x 1.1 x 1.3 cm. The patient was originally diagnosed with Gleason score 4+3 adenocarcinoma of the prostate by MR ultrasound fusion biopsy in 2012 and subsequently underwent treatment with proton beam radiation therapy. Results: MR-guided biopsy of the prostate August, 2014 confirmed the presence of locally recurrent PCa. Before MR-guided laser focal therapy, the biochemical recurrence was documented with an elevated serum PSA equal to 5.7. The 3- and 6-month post laser focal therapy serum PSA levels were 0.5. It reached a nadir of 0.3 at one year following the laser ablation. Patient had negative 6-month follow-up MR-guided biopsy of treatment region and remains on active surveillance Conclusions: Following proton beam radiation therapy, transrectal MR-guided laser focal therapy achieved oncologic control at 12 months post-treatment. Clinical trial information: 02243033.
Should patients have salvage robotic prostatectomy or salvage radiotherapy after focal therapy failure for locally recurrent prostate cancer?
