Focal salvage high‐intensity focused ultrasound in radiorecurrent prostate cancer

Kanthabalan, Abi; Peters, Max; Vulpen, Marco van; McCartan, Neil; Hindley, Richard G.; Emara, Amr; Moore, Caroline M.; Arya, Manit; Emberton, Mark; Ahmed, Hashim U.

doi:10.1111/bju.13831

Cited by 41 publications

(30 citation statements)

References 29 publications

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“…Focal salvage therapy specifically targets recurrence, decreasing the thermal dose and probability of damage to the surrounding tissues. Focal S‐HIFU after EBRT has demonstrated a decrease in morbidity with reasonable oncological outcomes . In the event of early detection of a unilateral recurrence after brachytherapy failure, hemi‐ablation leads to less harm, although the manner in which oncological outcomes are affected has not yet been determined.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, in the study by Crouzet et al [13] that evaluated S-HIFU post-EBRT, the introduction of specific post-EBRT parameters decreased severe incontinence, BOO and recto-urethral fistula. [33,34]. In the event of early detection of a unilateral recurrence after brachytherapy failure, hemi-ablation leads to less harm, although the manner in which oncological outcomes are affected has not yet been determined.…”

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confidence: 99%

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Salvage high‐intensity focused ultrasound for locally recurrent prostate cancer after low‐dose‐rate brachytherapy: oncological and functional outcomes

et al. 2019

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Objectives To evaluate the oncological and functional outcomes of salvage high‐intensity focused ultrasound (S‐HIFU) for locally recurrent prostate cancer after low‐dose‐rate (LDR) brachytherapy. Patients and Methods Clinical phase II studies (2003–2015) included 50 consecutive patients with post‐brachytherapy local recurrence treated by S‐HIFU. S‐HIFU was performed with post‐external beam radiotherapy (EBRT) parameters and, since 2008, with specific post‐brachytherapy parameters. Treatments were whole‐gland ablation and, since 2009, hemi‐ablation in cases of unilateral prostate cancer. The primary objective was to assess oncological outcomes: treatment failure‐free survival, progression‐free survival (PFS), overall survival (OS), cancer‐specific survival (CSS), and metastasis‐free survival (MFS) rates. The secondary objective was to evaluate adverse events, continence, and erectile function. Kaplan–Meier analysis estimated oncological outcomes. Results In all, 13 patients were treated with post‐EBRT parameters, 37 with post‐brachytherapy parameters, 35 with whole‐gland treatment, and 15 with hemi‐ablation. The median follow‐up was 4.6 years. After S‐HIFU, the median prostate‐specific antigen level was 0.3 ng/mL. At 6 years, treatment failure‐free survival, PFS, OS, CSS, and MFS rates were 41%, 45%, 93%, 98%, and 80%, respectively. Post‐brachytherapy compared with post‐EBRT parameters reduced Grade 2–3 incontinence (34% vs 62%, P = 0.015). Incontinence, bladder outlet obstruction and Grade ≥III complications were significantly reduced with hemi‐ablation compared with whole‐gland treatment (14% vs 54%, P < 0.001; 13% vs 46%, P = 0.03; 13% vs 63%, P = 0.001; respectively). Before S‐HIFU, 25 patients had a five‐item version of the International Index of Erectile Function score of ≥17, which was maintained in 48% at 12 months. Conclusion S‐HIFU for locally recurrent prostate cancer after LDR brachytherapy is associated with favourable survival rates at a price of significant morbidity. Dedicated post‐brachytherapy parameters and hemi‐ablation improve the safety of the treatment.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Salvage high‐intensity focused ultrasound for locally recurrent prostate cancer after low‐dose‐rate brachytherapy: oncological and functional outcomes

et al. 2019

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“…The biochemical recurrence free survival (BRFS) of the salvage HIFU after radiation therapy was based on Phoenix definition. In the two large volume reports [20] [21] about salvage HIFU after failed radiotherapy, the BRFS rates were 48% at 3 years and 49% at 5 years for the entire group. The BRFS rates were 100%, 61% and 32% at 3 years and 58%, 51% and 22% at 5 years in the low-, intermediate-and high-risk groups on pre-salvage HIFU, respectively.…”

Section: Discussionmentioning

confidence: 99%

Salvage Transrectal High-Intensity Focused Ultrasound Therapy for Patients with Recurrence of Vesico-Urethral Anastomosis after Radical Prostatectomy

Hayashi¹,

Hayashi²,

Oka³

et al. 2019

OJU

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Background: Salvage radiotherapy has been used as the treatment for patients with local recurrence after radical prostatectomy. However, the therapy is time-consuming and it experiences adverse effects of some kind. Simple and less invasive treatment is highly anticipated. Objectives: To evaluate the outcomes of salvage transrectal high-intensity focused ultrasound (HIFU) therapy for patients with localized recurrence of a vesicourethral anastomosis (VUA) after radical prostatectomy. Material and methods: Sixteen patients with suspected local recurrence of a VUA after prostatectomy were treated with HIFU. All patients had prostate-specific antigen (PSA) failure (>0.2 ng/ml), positive findings of a VUA with biopsy and/or MRI, TRUS and CT, and no distant metastasis by CT, MRI and bone scintigraphy before HIFU. Recurrence after HIFU was determined by PSA failure (>0.2 ng/ml), histological findings, metastasis and start of systemic therapies. Results: HIFU treatments were performed in 16 patients, and followed-up for 7-159 months (median 46.5). The pre-HIFU PSA levels ranged from 0.318 to 3.1 ng/ml. Sonication time ranged from 9-42 min. All patients had a decline of PSA after HIFU, and 88% of the PSA nadir was <0.2 ng/ml. Recurrence free survival (RFS) rates of 5 year were 31.3%. Nadir PSA was significantly associated with recurrence, whereas initial PSA, pre-HIFU PSA, duration and risk group after prostatectomy were not. There were no intraoperative adverse effects. In the 1-3 months after HIFU, there was some difficulty voiding in 4 cases (grade 1), urgency incontinence in 3 cases (grade 1 or 2). Conclusion: HIFU therapy for local recurrence after prostatectomy may become a feasible salvage therapeutic option because of its ease and simple procedure.

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“…Numerous strategies have been used to treat recurrent disease. Chapelon et al reported that salvage HIFU therapy after field external beam radiation therapy was increasing, and outcomes were similar to those achieved at surgery, with the advantage of fewer adverse effects, including urinary tract infections, bladder neck strictures, rectourethral fistulas, and osteitis pubis . Jones et al had similar results using whole‐gland HIFU.…”

Section: High‐intensity Focused Us In the Treatment Of Recurrencementioning

confidence: 93%

“…Patients with biochemical evidence of recurrence, which can occur in up to one‐third of men treated primarily with surgery or radiation therapy, are problematic, and treatment strategies in such patients can include androgen deprivation therapy (although this is associated with substantial side effects), radiotherapy, brachytherapy, proton therapy, and HIFU . All salvage treatments are more toxic to the patient than the primary treatment .…”

Section: High‐intensity Focused Us In the Treatment Of Recurrencementioning

confidence: 99%

Histotripsy: The Next Generation of High‐Intensity Focused Ultrasound for Focal Prostate Cancer Therapy

Dubinsky

Khokhlova

et al. 2019

J of Ultrasound Medicine

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This article reviews the most current methods and technological aspects of highintensity focused ultrasound (HIFU), which is termed histotripsy. The rationale for focal therapy for prostate carcinoma rather than prostatectomy, which is being used extensively throughout Europe and Asia, is presented, and an argument for why HIFU is the modality of choice for primary therapy and recurrent disease is offered. The article presents a review of the technical advances including higher ultrasound beam energy than current thermal HIFU which allows for more accurate tissue targeting, less collateral tissue damage, and faster treatment times. Finally, the article presents a discussion about the advantage of ultrasound guidance for histotripsy in preference to magnetic resonance imaging guidance primarily based on cost, ease of application, and portability.

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Focal salvage high‐intensity focused ultrasound in radiorecurrent prostate cancer

Cited by 41 publications

References 29 publications

Salvage high‐intensity focused ultrasound for locally recurrent prostate cancer after low‐dose‐rate brachytherapy: oncological and functional outcomes

Salvage high‐intensity focused ultrasound for locally recurrent prostate cancer after low‐dose‐rate brachytherapy: oncological and functional outcomes

Salvage Transrectal High-Intensity Focused Ultrasound Therapy for Patients with Recurrence of Vesico-Urethral Anastomosis after Radical Prostatectomy

Histotripsy: The Next Generation of High‐Intensity Focused Ultrasound for Focal Prostate Cancer Therapy

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