Brachytherapy as salvage treatment for local nodular recurrence of prostate cancer.

86 Background: Men diagnosed with adenocarcinoma of the prostate treated with radical prostatectomy (RP) have a 10% risk of developing local recurrence within 10 years. While the majority of these recurrences are biochemical failures with no foci of disease, we report on a series of 7 patients who had nodular recurrences in the post-surgical bed and subsequently underwent low-dose rate (LDR) brachytherapy as salvage therapy. Methods: Patients who were initially treated with RP and subsequently with salvage LDR I-125 brachytherapy for a nodular recurrence were included in this series. All patients failed biochemically within 10 years of RP and received no other adjuvant or salvage treatment by choice. Nodular recurrences were biopsy confirmed adenocarcinoma, and patients had no evidence of nodal or distant metastasis on imaging or bone scan. All patients consented to salvage with LDR brachytherapy. Follow up post-salvage was at least every 6 months with a serial PSA. Results: Seven patients underwent salvage LDR brachytherapy with median age of 74 (range 63-77) at time of salvage. The median pre-salvage PSA was 4.56. The biopsy Gleason score of the nodular recurrences was 7 or 8. Median volume of nodular recurrence was 16cc, median number of sources was 30, median D90 for nodule was 155.02 Gy, and median rectum V100 was 0.01. Compared to baseline prior to salvage, patients have reported no additional urinary symptoms or sexual side effects from salvage. Patients have been followed for a median of 28 months post-salvage (range 4-48 months) with a median PSA at last follow up of 1.05. Conclusions: This report presents the first known case series of prostate cancer patients treated with RP who developed local nodular recurrences which were then treated with LDR brachytherapy. For patients who develop a nodular recurrence with no other evidence of distant metastases, LDR brachytherapy offers a novel salvage option. No significant financial relationships to disclose.

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5207Bilateral cardiac sympathetic denervation in structural heart disease

European Heart Journal ◽

10.1093/eurheartj/ehz746.0065 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

V Dusi ◽

L Pugliese ◽

I Passarelli ◽

R Camporotondo ◽

M Driussi ◽

...

Keyword(s):

Heart Disease ◽

Nyha Class ◽

Case Series ◽

Structural Heart Disease ◽

Median Number ◽

Sympathetic Denervation ◽

Icd Shock ◽

Vt Ablation ◽

Cardiac Sympathetic Denervation

Abstract Background Left cardiac sympathetic denervation (LCSD) is an established therapy for refractory ventricular arrhythmias (VAs) in channelopathies. A multicentric American and Indian case series suggested a greater efficacy of bilateral denervation (BCSD) in patients with structural heart disease (SHD). Purpose To describe our single-center experience with BCSD in SHD. Methods Nine patients (78% male, mean 55±18 yrs, mean LVEF 31±14%) with SHD and refractory VAs underwent BCSD. All had a Video-Assisted Thoracoscopic Surgery (VATS), in 2 cases associated with the robotic technique. The underlying cardiomyopathy (CMP) was non-ischemic (NICMP) in most cases (n=5, 55%), ischemic in 2 cases, arrhythmogenic right ventricular (ARVC) in one and related to lamin A/C deficiency in one. All patients had an ICD, 44% (n=4) a CRT-D. NYHA functional class I was present in 4 patients, the rest were in NYHA class II (n=3) or III (n=2). Three patients were candidates to heart transplant/LV assistance device. The arrhythmic burden pre BCSD included in 7 pts (78%) a history of electrical storm (ES); the median number of shocks/patient in the 12 months before BCSD was 5 (IQ range 3–18). Except for 2 patients with previous thyrotoxicosis, the remaining were either on amiodarone (n=6) or on sotalol (n=1) before BCSD. Main BCSD indications were represented by drug refractory fast VT in 7 pts (cycle <250 msec) and by recurrent monomorphic VT episodes (mean cycle 351 msec) after endocardial VT ablation in 2 patients. Results No major complication occurred. One patient (NICMP, NYHA II), has an uneventful follow up (FU) of less than 1 month and was excluded from the efficacy analysis. The median FU in the remaining 8 patients is 10 months (IQ range 6–19), during which the median number of shocks/patients was 0.5 (IQ range 0–3). Overall, 4 patients (50%) had ICD shock recurrences. Two cases (mean LVEF 17.5%, NYHA class III) had an ES during severe hemodynamic instability and subsequently died because of cardiogenic shock respectively 1 and 7 months after BCSD. One case had three, not consecutive ICD shocks 20 months after BCSD in the setting of severe amiodarone-induced thyrotoxicosis. Finally, one patient received a single intra-hospital ICD shock 5 days after BCSD before reintroduction of full-dose beta-blockers. The figure summarizes ICD shocks burden in the 6 months before and after BCSD. Among the 5 patients with NICMP/ARVC (4 in NYHA class I), only 1 had a single ICD shock recurrence. ICD shocks pre versus post BCSD, n=8 Conclusions Our case series, although numerically small, has a good follow-up and is the first reported in Europe. The results are in agreement with the suggested remarkable efficacy of BCSD in patients with good functional capacity and fast VAs. Therefore, cardiac sympathetic denervation should always be considered in patients with SHD and refractory ventricular tachyarrhythmias, especially in case VT ablation is either not indicated or fails.

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Salvage robot-assisted radical prostatectomy (sRARP) for radiation resistant prostate cancer in a group of initially high risk patients

Nepalese Journal of Cancer ◽

10.3126/njc.v1i1.25628 ◽

2017 ◽

Vol 1 (1) ◽

pp. 21-27

Author(s):

Nirmal Lamichhane ◽

Adam S. Dowrick ◽

Ulrika Axcrona ◽

Bjørn Brennhovd ◽

Sophie D. Fosså ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

High Frequency ◽

Salvage Treatment ◽

Rectal Injury ◽

Robot Assisted ◽

Radiation Resistant ◽

Risk Patients

Introduction: Salvage robot-assisted radical prostatectomy (sRARP) is seen as an attractive option for salvage treatment of radiation therapy -recurrent prostate cancer (PC), thanks in part to the good visualisation that is possible using this modality. However, the results of fewer than 200 salvage sRARPs have been published in the literature. We report the outcomes in a cohort of initially high risk patients of robot-assisted radical prostatectomy as salvage local therapy for radiation-resistant PC in a Scandinavian healthcare setting. Materials and methods: A retrospective review of the charts of all patients who underwent sRARP for biochemical failure (BCF) after primary radiation treatment for localised PC at a single institution was performed. Results: Twenty-two patients, median age 67 years (range 57 to 72), had sRARP performed between June 2008 to July 2013. A median follow-up of 26 months (range 2 to 63) was observed. Perioperative complications occurred in 4 patients (18%), with one patient sustaining a rectal injury. Histo-pathological diagnosis was pT2 in three, pT3a in five, pT3b in twelve and pTx in one patient. Ten patients (45%) had a positive surgical margin (PSM). At follow-up, 54 % of patients were free of biochemical progression and 41% were continent. Conclusions: We showed that salvage RARP is technically feasible in a cohourt of patients with predominantly high risk disease. This study adds to the limited data already in the literature, demonstrating the high frequency of locally advanced (pT3b) PC, a patient group that is usually not included in salvage treatments, as e.g. high frequency ultrasound or salvage brachytherapy. Further, given that the historical barriers to salvage RP with higher rates of rectal injury and poor urinary control no longer seem to be applicable in the modern era, we think that more patients should be considered candidates for this potentially curative salvage treatment of radiation-resistant PC. However, long-term follow-up is needed to confirm if the additional burden on these patients confers to oncological control following the procedure.

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Immune checkpoint inhibitors in combination with radiotherapy as salvage treatment for relapsed/refractory classical Hodgkin lymphoma: A retrospective analysis in 12 patients

Hematology Reports ◽

10.4081/hr.2021.9080 ◽

2021 ◽

Vol 13 (2) ◽

Author(s):

Elisa Lucchini ◽

Chiara Rusconi ◽

Mario Levis ◽

Francesca Ricci ◽

Armando Santoro ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Median Number ◽

Brentuximab Vedotin ◽

Salvage Treatment ◽

Classical Hodgkin Lymphoma ◽

Highly Active

The rate of complete remission (CR) with the anti-PD1 immune checkpoint inhibitors (ICI) nivolumab (N) and pembrolizumab (P) in patients with relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL) is low (20-30%), and the majority of patients eventually relapse. One strategy to improve their outcome is to combine ICI with radiotherapy (ICI-RT), taking advantage of a supposed synergistic effect. We retrospectively collected data of 12 adult patients with R/R cHL treated with ICI-RT delivered during or within 8 weeks from the start or after the end of ICI. Median age at ICI-RT was 37 years, 50% had previously received an autologous stem cell transplantation (SCT) and 92% brentuximab vedotin. RT was given concurrently, before or after ICI in 4, 1 and 7 patients. Median RT dose was 30Gy, for a median duration of 22 days. Median number of ICI administrations was 15. Overall response and CR rate were 100% and 58%. Nine patients received subsequent SCT consolidation (7 allogeneic and 2 autologous). After a median follow-up of 18 months, 92% of patients were in CR. No major concerns about safety were reported. ICI-RT combination appears to be a feasible and highly active bridge treatment to transplant consolidation.

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11C-choline PET/CT in selection of patients for salvage cryoablation in recurrent prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.188 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 188-188

Author(s):

Anthonius J. Breeuwsma ◽

Maxim Rybalov ◽

Anna Maria Leliveld ◽

Rudi A. Dierckx ◽

Jan Pruim ◽

...

Keyword(s):

Prostate Cancer ◽

Distant Metastases ◽

Whole Body ◽

Choline Pet ◽

Prostate Biopsies ◽

Pet Ct ◽

Ct System ◽

Selection Of Patients ◽

Selection Of

188 Background: 11C-choline PET/CT has proven to be a sensitive technique for re-staging after radiation therapy (RT). The aim of this study was to analyze the clinical impact of 11C-choline-PET/CT in the selection of patients with biochemical recurrence (BCR) after RT for salvage cryoablation of the prostate. Methods: This prospective study was conducted between November 2006 and February 2012 on patients considered as candidates for salvage cryoablation. 74 patients, mean age 69.2 years, median – 70.3 years (range 49-79), who were being followed up after RT for histological proven prostate cancer (according to ASTRO-Phoenix) were included. Until 2009 we used PET/CT fusion, but from 2009 all patients were examined with an integrated PET/CT system. After receiving 400 MBq 11C-choline intravenously, a whole body scan was made. As reference we used biopsy-proven histology from site of suspicion, confirmative imaging modalities (bonescan, CT) or clinical follow-up. PSA doubling time and velocity was calculated. Results: According to the PET/CT results, 40 (54%) patients had a local recurrence, 20 (27%) had regional/distant metastases and 14 (19%) had a negative scan. The positive PET findings were proved by histology from prostate biopsies and/or pelvic lymph node dissections in 63% of cases. Considering PET/CT results: 50/74 (68%) patients received cryoablation, for 24/74 (32%) treatment was changed (active surveillance or androgen deprivation therapy). Conclusions: 11C-choline-PET/CT could be useful for the selection of patients with BCR after RT for salvage cryoablation of the prostate. 11C-choline-PET/CT was decisive and led to therapy change in 32% of cases. [Table: see text]

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Natural history of an immediately detectable PSA following radical prostatectomy: A description of a contemporary cohort.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.356 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 356-356

Author(s):

Peter Eoin Lonergan ◽

Samuel L. Washington ◽

Janet E. Cowan ◽

Hao Nguyen ◽

Matthew R. Cooperberg ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Natural History ◽

Locally Advanced ◽

Specific Antigen ◽

Salvage Treatment ◽

Post Surgery ◽

History Of

356 Background: Radical prostatectomy (RP) can provide good long-term oncological outcomes in patients with localized and locally advanced prostate cancer (PCa). After RP, prostate specific antigen (PSA) represents the corner stone for follow-up of patients. A persistently detectable PSA immediately following RP is an unfavourable prognostic factor. We described the natural history of the management and outcomes in men with a detectable PSA in an academic cohort. Methods: A retrospective review of prospectively collected clinical and pathologic data from consecutive patients who underwent RP for non-metastatic PCa between 2000 and 2018 was performed. A detectable PSA was defined as PSA ≥ 0.05 ng/ml between 2-6 months post-surgery. Biochemical recurrence (BCR) was defined as two consecutive PSA values ≥ 0.2 ng/ml after 6 months post-surgery or any salvage treatment for a rising PSA. Second recurrence was defined as additional treatment after post-RP salvage treatment. Outcomes were defined as time to other cause mortality (OCM) or prostate cancer specific mortality (PCSM). Results: We identified 499 men with a detectable PSA within 6 months following RP. Median PSA at diagnosis was 7.95 ng/ml (IQR 5.57-12.97). Median CAPRA-S score was 5 (IQR 2-7). Median follow-up was 41 months (IQR 20-77). 296 (59%) underwent salvage treatment for a rising PSA at a median of 5 months. 33 (23%) of these men required further treatment (10 for bone metastases) at a median of 7 months. 203 (41%) of men with an immediately detectable PSA did not undergo any further treatment after RP. Treatment-free survival after post-RP salvage (31 on ADT and 2 underwent salvage RT) in men with a detectable vs undetectable PSA was 86% vs 92% at 1 year, 78% vs 89% at 3 years, 72% vs 86% at 5 years and 70% vs 76% at 10 years (Log-rank p =0.02). Prostate cancer specific survival in men with a detectable vs undetectable PSA was 100% vs 100% at 1 year, 99% vs 100% at 3 years, 96% vs 100% at 5 years and 91% vs 99% at 10 years (Log-rank p < 0.01). Conclusions: This report describes the natural history of the management and outcomes in men with a detectable PSA following RP. We demonstrate that men with a detectable PSA after RP may have excellent long-term outcomes.

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Interim analysis of STARTAR: A phase II salvage trial of androgen receptor (AR) inhibition with androgen deprivation therapy (ADT) and apalutamide with radiation therapy (RT) followed by docetaxel in men with PSA recurrent prostate cancer (PC) after radical prostatectomy (RP).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.90 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 90-90

Author(s):

Tian Zhang ◽

Bridget F. Koontz ◽

Scott T. Tagawa ◽

Himanshu Nagar ◽

Rhonda L. Bitting ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Interim Analysis ◽

Salvage Treatment ◽

Research Network ◽

Phase 2 ◽

Phase 2 Trial ◽

Psa Recurrence ◽

Grade 3

90 Background: ADT with salvage RT improves survival for men with PSA recurrence after RP. Current standard duration of ADT for high risk PSA recurrence is up to 2 years with RT; therefore shortening but intensifying systemic therapy may improve outcomes. The STREAM trial showed 6 mo of enzalutamide added to ADT/RT had a 3-year progression free survival (PFS) of 53% in high risk patients including lymph node (LN) positive. Given that docetaxel improves survival in men with mHSPC, we evaluated the combination of salvage RT, ADT/apalutamide and docetaxel in this setting. Methods: STARTAR is a multicenter phase 2 trial for salvage treatment of PSA recurrent PC following RP conducted within the US Dept. of Defense Prostate Cancer Clinical Trials Consortium (DOD PCCTC). Key inclusion criteria included PC with Gleason 7 with T3/positive margin/1-4 positive LNs or Gleason 8-10 disease and PSA relapse within 4 years of RP (min PSA 0.2 ng/mL to max PSA 4 ng/mL). Men with up to 4 positive resected LNs were eligible. Men started ADT with apalutamide, continued with RT (66-74 Gy to the prostate bed +/- pelvic LNs over 6-8 weeks), and finally completed docetaxel 75mg/m2 IV q3 weeks for 6 cycles. Men were treated with ADT and apalutamide for approximately 9 months. The primary endpoint was PSA PFS at 36 months. This interim analysis evaluated secondary endpoints of 1-year PSA recurrence, testosterone recovery, and safety of this treatment sequence. Results: From 3/2018 to 12/2019, 39 men were enrolled at Duke, Wake Forest, Cornell, and the GU Research Network. With a data cutoff in 9/2020, median follow up from enrollment was 14 months. Baseline patient characteristics included Gleason 4+3 = 7 in 54% and Gleason 8-10 in 46%, and 23% LN positive; median PSA at the time of enrollment was 0.58 ng/mL (range 0.21-3.40) and the median time from RP to enrollment was 7 mo (range 2-98). At 1 year, there have been no progression events with 38% (12/31) of men with post-treatment testosterone recovery into normal range (recovery time median 10 mos [1-17 mos]). Common adverse events (AEs) of any-grade at least possibly related to the regimen were 98% hot flashes, 88% fatigue, 77% alopecia, 57% dysgeusia, and 53% rash (28% grade 1; 15% grade 2, 10% grade 3), with neutropenia as the most common grade 3/4 AE (27/39 men, 70%) with two grade 3 febrile neutropenia. Conclusions: In this first phase 2 trial of ADT, apalutamide, radiation, and 6 cycles docetaxel in the salvage setting for high risk PSA recurrence, short term outcomes are excellent with no recurrences at 12 months of follow-up. This salvage treatment was well tolerated in the majority of men with the exception of a high rate of drug rashes and neutropenia related to the course of treatment, in line with known safety profiles of the study agents. Clinical trial information: NCT03311555.

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Cabazitaxel multiple rechallenge in metastatic castration-resistant prostate cancer: A therapeutic option to increase overall survival?

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.97 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 97-97

Author(s):

Cedric Pobel ◽

Edouard Auclin ◽

Diego Teyssonneau ◽

Brigitte Laguerre ◽

Mathilde Cancel ◽

...

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Therapeutic Option ◽

Progression Free Survival ◽

Median Number ◽

Castration Resistant Prostate Cancer ◽

Free Survival ◽

Castration Resistant ◽

Grade 3

97 Background: Cabazitaxel rechallenge could be a more efficient therapy with an acceptable toxicity than docetaxel in the treatment of patients with a metastatic castration resistant prostate cancer (mCRPC). The aim of this study was to assess the feasibility and efficacy of cabazitaxel multiple rechallenge. Methods: This is a multicenter, retrospective cohort study including patients from 9 centers in France who received 3 lines or more of cabazitaxel from February 2012 to July 2020. Cabazitaxel schedule differed between patients: 25 mg/m2 q3w, 20 mg/m2 q3w, 16 mg/m2 q2w or 10 mg/m2 weekly. Efficacy was assessed by overall survival (OS) and progression-free survival (PFS) from each cabazitaxel line start. Only toxicities grade ≥ 3 were reported. Results: Twenty-two patients were included. The median follow-up from mCRPC was 94.7 months, median age at initial diagnosis was 59.5 years old, median ISUP score at diagnosis was 4 and median PSA at diagnosis was 55 ng/ml. Median number of cabazitaxel cycles was 7 at first-line, 6 at first rechallenge, and 5 for subsequent rechallenges. Median OS from mCRPC diagnosis was 105 months. Median PFS from cabazitaxel line start was 11.8 months at first use, 9.6 for first rechallenge and 5.6 in second rechallenge (table). Only one case of febrile neutropenia and 6 events of grade ≥ 3 toxicity were reported. Conclusions: Cabazitaxel multiple rechallenge could efficiently extend OS with manageable toxicities for patients. Even if anti-PARP therapy and immunotherapy are promising treatments, cabazitaxel rechallenge could be also a relevant therapeutic option for long responder patients. Specific biomarkers should be explored to predict the efficacy of cabazitaxel rechallenge. [Table: see text]

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Evaluation of the effectiveness and acceptability of the long-acting oral antipsychotic penfluridol: Illustrative case series

Journal of Psychopharmacology ◽

10.1177/02698811211050561 ◽

2021 ◽

pp. 026988112110505

Author(s):

Danielle Dunnett ◽

Ebenezer Oloyede ◽

Oluwakemi Oduniyi ◽

Barbara Arroyo ◽

Olubanke Dzahini ◽

...

Keyword(s):

Psychotic Disorders ◽

Case Series ◽

Median Number ◽

Illustrative Case ◽

The United Kingdom ◽

Duration Of Illness ◽

National Health Service Trust ◽

Oral Antipsychotic ◽

Long Acting

Aim: In this study, we sought to determine clinical outcomes at 1 year for patients prescribed penfluridol in an inner London National Health Service Trust. Using noninterventional data, we describe the use, effectiveness and safety of this treatment modality. Results: We retrospectively followed up 17 patients prescribed penfluridol as part of routine clinical practice. All patients took penfluridol once weekly. Of these patients, 12 (70.6%) were considered treatment resistant. The average duration of illness for this cohort was 10 years (SD = 6.7). At 1 year, nine (53%) patients remained on treatment. Median survival time was not reached at 1-year follow-up; mean time on penfluridol was 251 days (95% confidence interval (CI), 184–318). The mean number of admissions to hospital in the year following penfluridol initiation was 0.6 compared with 0.8, 1 year before initiation ( p = 0.465). The median number of bed days 1 year before penfluridol initiation was 24, whereas in the year following penfluridol initiation, it was 0 ( p = 0.514). Clinical Implications: Although penfluridol is unlicensed in the United Kingdom, limited data suggest that this long-acting oral therapy has the potential to be used safely and effectively for the treatment of psychotic disorders. However, more data are required to establish the place of penfluridol and other potential long-acting oral antipsychotic formulations in the treatment of psychotic disorders.

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Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation

Health Technology Assessment ◽

10.3310/hta19490 ◽

2015 ◽

Vol 19 (49) ◽

pp. 1-490 ◽

Cited By ~ 48

Author(s):

Craig R Ramsay ◽

Temitope E Adewuyi ◽

Joanne Gray ◽

Jenni Hislop ◽

Mark DF Shirley ◽

...

Keyword(s):

Prostate Cancer ◽

Cost Effectiveness ◽

Case Series ◽

Health Technology ◽

Primary Treatment ◽

Salvage Treatment ◽

Controlled Trials ◽

Ablative Therapies ◽

Ablative Procedures

BackgroundFor people with localised prostate cancer, active treatments are effective but have significant side effects. Minimally invasive treatments that destroy (or ablate) either the entire gland or the part of the prostate with cancer may be as effective and cause less side effects at an acceptable cost. Such therapies include cryotherapy, high-intensity focused ultrasound (HIFU) and brachytherapy, among others.ObjectivesThis study aimed to determine the relative clinical effectiveness and cost-effectiveness of ablative therapies compared with radical prostatectomy (RP), external beam radiotherapy (EBRT) and active surveillance (AS) for primary treatment of localised prostate cancer, and compared with RP for salvage treatment of localised prostate cancer which has recurred after initial treatment with EBRT.Data sourcesMEDLINE (1946 to March week 3, 2013), MEDLINE In-Process & Other Non-Indexed Citations (29 March 2013), EMBASE (1974 to week 13, 2013), Bioscience Information Service (BIOSIS) (1956 to 1 April 2013), Science Citation Index (1970 to 1 April 2013), Cochrane Central Register of Controlled Trials (CENTRAL) (issue 3, 2013), Cochrane Database of Systematic Reviews (CDSR) (issue 3, 2013), Database of Abstracts of Reviews of Effects (DARE) (inception to March 2013) and Health Technology Assessment (HTA) (inception to March 2013) databases were searched. Costs were obtained from NHS sources.Review methodsEvidence was drawn from randomised controlled trials (RCTs) and non-RCTs, and from case series for the ablative procedures only, in people with localised prostate cancer. For primary therapy, the ablative therapies were cryotherapy, HIFU, brachytherapy and other ablative therapies. The comparators were AS, RP and EBRT. For salvage therapy, the ablative therapies were cryotherapy and HIFU. The comparator was RP. Outcomes were cancer related, adverse effects (functional and procedural) and quality of life. Two reviewers extracted data and carried out quality assessment. Meta-analysis used a Bayesian indirect mixed-treatment comparison. Data were incorporated into an individual simulation Markov model to estimate cost-effectiveness.ResultsThe searches identified 121 studies for inclusion in the review of patients undergoing primary treatment and nine studies for the review of salvage treatment. Cryotherapy [3995 patients; 14 case series, 1 RCT and 4 non-randomised comparative studies (NRCSs)], HIFU (4000 patients; 20 case series, 1 NRCS) and brachytherapy (26,129 patients; 2 RCTs, 38 NRCSs) studies provided limited data for meta-analyses. All studies were considered at high risk of bias. There was no robust evidence that mortality (4-year survival 93% for cryotherapy, 99% for HIFU, 91% for EBRT) or other cancer-specific outcomes differed between treatments. For functional and quality-of-life outcomes, the paucity of data prevented any definitive conclusions from being made, although data on incontinence rates and erectile dysfunction for all ablative procedures were generally numerically lower than for non-ablative procedures. The safety profiles were comparable with existing treatments. Studies reporting the use of focal cryotherapy suggested that incontinence rates may be better than for whole-gland treatment. Data on AS, salvage treatment and other ablative therapies were too limited. The cost-effectiveness analysis confirmed the uncertainty from the clinical review and that there is no technology which appears superior, on the basis of current evidence, in terms of average cost-effectiveness. The probabilistic sensitivity analyses suggest that a number of ablative techniques are worthy of further research.LimitationsThe main limitations were the quantity and quality of the data available on cancer-related outcomes and dysfunction.ConclusionsThe findings indicate that there is insufficient evidence to form any clear recommendations on the use of ablative therapies in order to influence current clinical practice. Research efforts in the use of ablative therapies in the management of prostate cancer should now be concentrated on the performance of RCTs and the generation of standardised outcomes.Study registrationThis study is registered as PROSPERO CRD42012002461.FundingThe National Institute for Health Research Health Technology Assessment programme.

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