Détection par IRM des récidives locales du cancer de prostate après traitement par ultrasons focalisés de haute intensité (HIFU) transrectaux : étude préliminaire

BackgroundTreatment options for radio-recurrent prostate cancer are either androgen deprivation therapy or salvage prostatectomy. Whole-gland HIFU might have a role in this setting.MethodsAn independent HIFU registry collated consecutive cases of HIFU. Between 2005 and 2012 we identified 50 men who underwent whole-gland HIFU following histological confirmation of localized disease following prior external beam radiotherapy (2005-2012).No upper threshold was applied for risk category, Prostate Specific Antigen (PSA), or Gleason grade either at presentation or at time of failure.Progression was defined as a composite with either biochemical failure (Phoenix criteria [PSA>nadir+2ng/mL]), start of systemic therapies or metastases.ResultsMedian age (IQR), pre-treatment PSA (IQR), and Gleason score (range), were 68years (64-72), 5.9ng/mL (2.2-11.3), and 7 (6-9), respectively. Median follow-up was 64months (49-84).24/50 (48%) avoided androgen deprivation therapies. 28/50 (56%) achieved a PSA-nadir <0.5ng/ml. 15/50 (30%) had a nadir ≥0.5ng/ml. 7/50 (14%) did not nadir (PSA non-responders).Actuarial 1, 3 and 5-year PFS was 72%, 40% and 31%, respectively. Actuarial 1, 3, and 5-year OS was 100%, 94% and 87%, respectively.When comparing patients with PSA nadir <0.5ng/ml, nadir ≥0.5 and non-responders a statistically significant difference in PFS was seen (p<0.0001). 3-year PFS in each group was 57%, 20% and 0%, respectively. 5-year overall survival was 96%, 100% and 38%, respectively.Early in the learning curve, between 2005-2007, 3/50 (6%) developed a fistula. Intervention for bladder outlet obstruction was needed in 27/50 (54%). Patient-reported outcome measures questionnaires showed incontinence (any pad-use) as 8/26 (31%).ConclusionsIn our series of high-risk patients, in whom 30-50% may have micro-metastases, disease control rates were promising in PSA-responders, however with significant morbidity.Additionally, post-HIFU PSA-nadir appears to be an important predictor for both progression and survival.Further research on focal salvage ablation in-order to reduce toxicity whilst retaining disease control rates is required.

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“…The positive predictive value for MRI also appears to be high in the post-HIFU setting. 12 , 13 , 14 , 15 , 16 …”

Section: Resultsmentioning

confidence: 99%

PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure

Shah

Peters

Kanthabalan

et al. 2016

Prostate Cancer Prostatic Dis

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“…[18][19][20] Furthermore, a strong correlation has been found between rising PSA levels and the detection of recurrence on PSMA PET scans. Perera et al (2020) performed a systematic review and meta-analysis of the utility of 68 Ga-PSMA-PET in assessing advanced or biochemically recurrent prostate cancer. In their analysis, which included six studies providing data following primary radiotherapy failure, they discovered that the percentage positivity of PSMA-PET scans for assessing recurrence increased with rising pre-PET PSA levels.…”

Section: Post-radiation Recurrencementioning

confidence: 99%

“…In their analysis, which included six studies providing data following primary radiotherapy failure, they discovered that the percentage positivity of PSMA-PET scans for assessing recurrence increased with rising pre-PET PSA levels. [21] A 2017 study conducted at Royal North Shore Hospital in Australia investigated the role of 68 Ga-PSMA-PET in patients with post-external beam radiotherapy treatment (EBRT) biochemical failure, defined as nadir PSA ≥2 ng/ml. [18] Patient selection included a cohort of n=419 men treated with image-guided EBRT at dose 78 or 82 Gy +/-ADT between 2007 and 2014.…”

Section: Post-radiation Recurrencementioning

confidence: 99%

The Role of Whole-Gland and Focal Cryotherapy in Recurrent Prostate Cancer

Pio,

Murdock,

Fuller

et al. 2024

Preprint

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Prostate cancer is the most common non-cutaneous malignancy in men, with the majority of newly diagnosed patients eligible for active surveillance. Despite definitive treatment, a considerable percentage of men will experience biochemical recurrence and even regional and distant metastatic recurrence after radiation therapy or radical prostatectomy. Salvage prostatectomy, while oncologically effective, poses significant morbidity with poor functional outcomes. Salvage cryotherapy has emerged as a promising alternative for localized recurrence, demonstrating safety and efficacy. This review examines the oncologic and functional outcomes of whole-gland and focal salvage cryotherapy, including disease-free survival, cancer-specific survival, and overall survival. The crucial role of multiparametric prostate MRI and evolving role of next-generation PSMA-targeted PET imaging is also examined. Comparison of outcomes of cryotherapy to other salvage ablation modalities, such as high-intensity focused ultrasound (HIFU) is also explored.

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“…Although contrast enhanced T1-weighted MRI can detect tissue damage following HIFU ablation (86, 87), it does not correlate to histological results (intensity of necrosis, presence of foci of viable cancer) immediately following HIFU (87). However, for follow-up examinations, DCE MRI has demonstrated good sensitivity and diffusion MRI has shown specificity in identifying tumor progression after HIFU ablation (75, 88). …”

Section: Application Of Imaging Technologymentioning

confidence: 99%

Ultrasonic Enhancement of Drug Penetration in Solid Tumors

Lai¹,

Fite²,

Ferrara³

2013

Front. Oncol.

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Increasing the penetration of drugs within solid tumors can be accomplished through multiple ultrasound-mediated mechanisms. The application of ultrasound can directly change the structure or physiology of tissues or can induce changes in a drug or vehicle in order to enhance delivery and efficacy. With each ultrasonic pulse, a fraction of the energy in the propagating wave is absorbed by tissue and results in local heating. When ultrasound is applied to achieve mild hyperthermia, the thermal effects are associated with an increase in perfusion or the release of a drug from a temperature-sensitive vehicle. Higher ultrasound intensities locally ablate tissue and result in increased drug accumulation surrounding the ablated region of interest. Further, the mechanical displacement induced by the ultrasound pulse can result in the nucleation, growth and collapse of gas bubbles. As a result of such cavitation, the permeability of a vessel wall or cell membrane can be increased. Finally, the radiation pressure of the propagating pulse can translate particles or tissues. In this perspective, we will review recent progress in ultrasound-mediated tumor delivery and the opportunities for clinical translation.

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Détection par IRM des récidives locales du cancer de prostate après traitement par ultrasons focalisés de haute intensité (HIFU) transrectaux : étude préliminaire

Cited by 29 publications

References 30 publications

PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure

PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure

The Role of Whole-Gland and Focal Cryotherapy in Recurrent Prostate Cancer

Ultrasonic Enhancement of Drug Penetration in Solid Tumors

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