Salvage radiotherapy after high-intensity focused ultrasound treatment for localized prostate cancer: feasibility, tolerance and efficacy

Background: The objective of this study is to evaluate the feasibility,tolerance and efficacy of salvage external beam radiotherapy(EBRT) in persistent or recurrent prostate cancer after failed highintensity focused ultrasound (HIFU) therapy.Methods: We reviewed data on tolerance and oncologic outcomesfor all patients with biopsy-proven locally recurrent or persistentprostate cancer who underwent salvage EBRT in our departmentbetween April 2004 and June 2008. Minimum follow-up for inclusionwas 2 years. Failure with EBRT was defined as biochemicalrelapse (Phoenix definition) or introduction of androgen deprivationtherapy (ADT). Gastrointestinal and urinary toxicity and urinary stressincontinence were scored at 12 and 24 months (Radiation TherapyOncology Group and Ingelman Sundberg rating, respectively).Results: The mean age of the patients was 68.8 years (range: 60-79).Mean prostate-specific antigen (PSA) before EBRT was 5.57 ng/mL(range: 2.5-14.8). Median follow-up was 36.5 ± 10.9 months(range: 24-54). No patient received adjunctive ADT. The EBRTcourse was well-tolerated and completed by all patients. The meanPSA nadir was 0.62 ng/mL (range: 0.03-2.4) and occurred after amedian of 22 months (range: 12-36). One patient experiencedbiochemical failure and was prescribed ADT 30 months after EBRT.The disease-free survival rate was 83.3% at 36.5 months. Therewas no major EBRT-related toxicity at 12 or 24 months.Conclusions: Our early clinical results confirm the feasibilityand good tolerance of salvage radiotherapy after HIFU failure.Oncological outcomes were promising. A prospective study withlonger follow-up is needed to identify factors predictive of successfor salvage EBRT therapy after HIFU failure.

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Prostate Cancer: Transrectal High-Intensity Focused Ultrasound for the Treatment of Local Recurrence after Radical Prostatectomy or Radiotherapy

Urologia Journal ◽

10.1177/039156030907600204 ◽

2009 ◽

Vol 76 (2) ◽

pp. 73-76 ◽

Cited By ~ 1

Author(s):

M. Tasso ◽

F. Varvello ◽

U. Ferrando

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Focused Ultrasound ◽

External Beam Radiotherapy ◽

High Intensity Focused Ultrasound ◽

Biochemical Relapse ◽

Vesicourethral Anastomosis ◽

Disease Free

Objectives To evaluate the efficacy and safety of transrectal high-intensity focused ultrasound (HIFU) as salvage therapy for locally recurrent prostate cancer after external beam radiotherapy or recurrences located in the region of vesicourethral anastomosis after radical prostatectomy. Methods Transrectal biopsy of the prostate (recurrence after radiotherapy) or in the region of vesicourethral anastomosis (recurrence after prostatectomy) was performed in all cases at the time of biochemical relapse. Only patients with positive biopsy were treated. Systemic disease was excluded by PET-CT and bone scan. All treatments were carried out under spinal anesthesia. The device used was Ablatherm (EDAP, Lion, France). The patients were followed with PSA measurement every 3 months and clinical examination every 6 months. In case of biochemical relapse we performed re-biopsy. Results From 2002 to 2008 we treated 19 patients with local recurrence after radiotherapy. The mean follow-up was 30 months for each patient (range 6–72 months). 9 patients (47%) are disease-free at last follow-up, with PSA < 1 ng/mL. 9 patients experienced biochemical failure: 8 were treated with androgen deprivation, 1 with salvage prostatectomy. 2 patients died of the disease. Adverse events related to HIFU included 1 rectourethral fistula (observed before the use of specific parameters dedicated to this patient population) and mild incontinence (2–3 pads/die) in 4 patients. From 2002 to 2008 we treated 27 patients with a local recurrence after radical prostatectomy. Mean pre-HIFU PSA was 2.17 ng/mL (range 0.5–8 ng/ml); the Gleason score ranged from 5 to 8. All patients reached a minimum follow-up of 20 months (range 20–80 months). Median PSA nadir was 0.2 ng/ml. The disease-free rate was 51% (14/27); these patients have a median PSA of 0.2 ng/ml at last follow-up. 81% (22/27) of control biopsies were negative. There were no intra-operative or post-operative complications. Conclusions The small number of patients in our series limits our ability to draw any definitive conclusions. We believe that HIFU may be a potentially useful treatment option for patients who develop prostate cancer recurrence after external beam radiotherapy or in the region of vesicourethral anastomosis after radical prostatectomy. The procedure is safe, side effects are acceptable and do not add significant morbidity to the previous radical treatment. HIFU lesions are targeted only to the area of recurrence. It is important to remember that, in case of failure, the patient can undertake any other therapies.

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