HIFU as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer after radical prostatectomy: A pilot study

Abstract

Objective: To test high-intensity focused ultrasound (HIFU) as salvage first-line treatment for palpable, TRUS-evidenced, biopsyproven locally recurrent prostate cancer (CaP) after radical prostatectomy (RP). Materials and methods:Nineteen patients with palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP after RP, unwilling to undergo salvage radiotherapy (SRT), underwent HIFU as a single-session procedure. Pre-, intra-, and postoperative data including early and late complications, and oncologic outcomes (PSA nadir, biochemical recurrence (BCR)-free survival, and need of secondary adjuvant treatment) were prospectively evaluated. Success was defined as PSA nadir Յ0.1 ng/ml obtained within 3 months from HIFU. In case of PSA nadir Ͼ0.1 ng/ml or PSA increase Ն1 ng/ml above the PSA nadir, a biopsy of the treated lesion was performed, and if negative, maximum androgen blockade (MAB) was adopted. In case of positive biopsy, RT was performed. Failure was defined as use of secondary adjuvant treatment (MAB or RT).Results: Median follow-up was 48 months. All cases were performed as overnight procedure. No case of urethrorectal fistula or anastomotic stricture was observed. Two cases of acute urinary retention were resolved with prolonged urethral catheterization. Four cases of stress urinary incontinence were observed; 2 (mild incontinence) were resolved after pelvic floor exercises within 6 months, while 2 cases of severe incontinence required surgical minimally invasive treatment;17/19 patients (89,5%) were classified as success. Two patients failed to show a PSA nadir Ͻ0.1 ng/ml. During follow-up, 8/17 patients (47%) were classified as failure, with consequent total rate of failures 10/19 (52.6%). A statistically significant difference was observed in pre-HIFU median PSA (2 vs. 5.45 ng/ml, respectively, P ϭ 0.013) and Gleason score of the RP specimen (P ϭ 0.01) between the success and failure group.Conclusions: Salvage first-line HIFU for palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP is a feasible, minimally invasive day-case procedure, with an acceptable morbidity profile. It seems to have a good cancer control in the short-and mid-term. Patients with lower pre-HIFU PSA level and favorable pathologic Gleason score presented better oncologic outcomes. A prospective randomized trial with an adequate recruitment and follow-up is necessary to confirm our preliminary oncologic results.

High-intensity focused ultrasound in prostate cancer: Today's outcomes and tomorrow's perspectives

“…During follow-up, eight out of 17 patients (47%) were classified as failures, with the consequent total rate of failures being 10 out of 19 (52.6%). A statistically significant difference was observed in pre-HIFU median PSA (2 vs 5.45 ng/ml, respectively, p = 0.013) and Gleason score of the RP specimen (p = 0.01) between the success and failure groups [28].…”

“…Patients with lower pre-HIFU PSA levels and favourable pathological Gleason scores had better oncological outcomes [27][28][29][30][31].…”

“…To date, however, using a smaller quantity of focused energy for a shorter time in patients with recurrent cancer tissue, the damage to the surrounding structures (including the rectal wall and external urethral sphincter) is low, minimizing the risk of complications such as urethrorectal fistula, anastomotic strictures and incontinence [28].…”

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

“…There are some salvage therapies for recurrence after radical treatment of localized prostate cancer [16] [17] [18]. For salvage HIFU therapy, although there are many reports for radio-recurrent prostate cancer in recent years [19] [20] [21], there are only a few reports [22] [23] for recurrence after prostatectomy available besides our reports [13] [14] and those of Murota-Kawano [24]. After our first report of salvage HIFU therapy for four patients after prostatectomy [13], we performed salvage focal HIFU on lesions at the VUA in a total of 16 cases.…”

Conservative treatment of a recto-urethral fistula due to savage HIFU for local recurrence of prostate cancer, 5 years after radical prostatectomy and external beam radiotherapy

“…Even though this is not a standard indication, we decided to carry out this treatment on the basis of a promising experience, already published by our group1 on HIFU used as salvage therapy for local recurrence of PCa after radical prostatectomy. Therefore, the patient underwent a salvage HIFU treatment using the Ablatherm system (EDAP-TMS, Vaulx-en-Velin, France) in a single 1 h session.…”