High‐intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after external beam radiation, brachytherapy or proton therapy

• Published in: BJU international Vol. 107; no. 3; pp. 378 - 382
• Main Authors: Uchida, Toyoaki, Shoji, Sunao, Nakano, Mayura, Hongo, Satoko, Nitta, Masahiro, Usui, Yukio, Nagata, Yoshihiro
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2011; Wiley-Blackwell
• Subjects: Age; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Brachytherapy; Epidemiologic Methods; Epididymitis; Genital system. Mammary gland; HIFU; Humans; Male; Malignancy; Medical sciences; Middle Aged; Morbidity; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Nephrology. Urinary tract diseases; Prostate cancer; prostate-specific antigen; Prostate-Specific Antigen - metabolism; Prostatic Neoplasms - pathology; Prostatic Neoplasms - therapy; Protons; Protons - therapeutic use; Radiation; radiation therapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk groups; salvage therapy; Salvage Therapy - methods; Side effects; Stenosis; Survival; Treatment Outcome; Tumors of the urinary system; Ultrasound; Ultrasound, High-Intensity Focused, Transrectal; Urinary tract. Prostate gland; Human; Nephrology; Urinary system disease; High intensity focused ultrasound; Prostate disease; Ultrasonic treatment; Instrumentation therapy; Malignant tumor; Recurrent; Proton therapy; Radiotherapy; Urology; Extracorporeal irradiation; HIFU; Cancerology; radiation therapy; Salvage treatment; salvage therapy; Male genital diseases; Prostate cancer; Curietherapy; Cancer
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09518.x

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Salvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment. This study showed a long‐term follow up of salvage HIFU in men with recurrence of localized prostate cancer following not only external beam radiation therapy but also brachytherapy or proton therapy. OBJECTIVE To investigate the use of high‐intensity focused ultrasound (HIFU) as a salvage therapy in patients with recurrence of localized prostate cancer after external beam radiation (EBRT), brachytherapy, or proton therapy. PATIENTS AND METHODS We retrospectively reviewed the charts of all patients who had undergone salvage HIFU for biopsy‐proven prostate cancer after primary radiation therapy. Patient characteristics and oncological outcomes were assessed. RESULTS Records of 22 patients with a median (range) follow‐up of 24 (5–80) months were reviewed. Patients were men with presumed organ‐confined disease who had been treated with salvage HIFU following recurrent disease after EBRT (fourteen patients), brachytherapy (five patients: four with high‐dose brachytherapy using In192; and one with low‐dose brachytherapy using Au98) or proton therapy (three patients). The median (range) age at salvage HIFU was 65 (52–80) years, with a median (range) prostate‐specific antigen (PSA) level before radiation therapy of 14.3 (5.7–118) ng/mL and a median (range) PSA level of 4.0 (1.2–30.1) ng/mL before HIFU. The median (range) period to HIFU after radiation therapy was 36 (4–96) months. The biochemical disease‐free survival (bDFS) rate in all patients at 5 years was 52%. Rates of bDFS in low‐, intermediate‐ and high‐risk groups were 100%, 86%, and 14%, respectively. One of the twelve patients who received post‐HIFU prostate biopsy showed malignancy. Side effects included urethral stricture in four patients, grade I urinary incontinence in four patients, rectourethral fistula and epididymitis in one of each patient. CONCLUSION Salvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment.