Histological changes in the human prostate after radiotherapy and salvage high intensity focused ultrasound

The histological changes (both macroscopic and microscopic) in theprostate following the combination of external beam radiotherapyand salvage high intensity focused ultrasound (HIFU) have notbeen previously described. This article describes the case of a65-year-old male who presented with recurrent localized prostatecancer after undergoing external beam radiotherapy for low-riskprostate cancer. He was treated with salvage HIFU, and 4 weekslater presented with symptoms and signs consistent with a prostatorectalfistula. During a period of conservative management, hisserum prostate-specific antigen levels started rising after havingreached a nadir. A radical cystoprostatectomy and repair of fistulawere performed after conservative management failed. Histologicalchanges of dense fibrosis were noted in the region where theprostate should have been located. A literature review of thehistological findings in the prostate after HIFU is discussed in thisarticle, as well as the available evidence for the management ofpatients with local failure after the combination of external beamradiotherapy and salvage HIFU.