High-Intensity Focused Ultrasound and Cryotherapy as Salvage Treatment in Local Radio-Recurrent Prostate Cancer

Abstract

Background: Salvage high-intensity focused ultrasound (HIFU) and cryotherapy (CRYO) have emerged as interesting alternatives in the treatment of local radio-recurrent prostate cancer. Currently, recommendations concerning the use of CRYO and HIFU in the salvage setting are still evolving. Aim: The objective of this review was to analyze the results from studies on CRYO and HIFU as salvage treatment in local radio-recurrent prostate cancer. Materials and Methods: A National Center for Biotechnology Information PubMed search (www.pubmed.gov) was conducted from 1993 to 2011 using medical subject headings ‘High-Intensity Focused Ultrasound’, ‘Cryotherapy’, ‘Local Radio-Recurrent’ and ‘Prostate Cancer’. Results: In the past years, there have been several published series demonstrating promising acceptable morbidity and oncological outcomes in the short term for HIFU and in the intermediate term for CRYO. The introduction of newer-generation devices and technical modifications has facilitated reduction of complications associated with the procedures. As with any salvage treatment, careful patient selection and subsequent follow-up are principal points. Conclusions: HIFU and CRYO are promising salvage treatments in patients with local radio-recurrent prostate cancer. The risk of significant complications in the salvage setting is higher compared with primary therapy; therefore, the patients must be informed about the risk of complications and the modality of treatment. However, only further evaluation in formal prospective clinical trials will hopefully confirm their role in clinical practice.

Salvage cryotherapy for prostate cancer

“…Salvage radical prostatectomy for recurrence after radiotherapy is an accepted alternative although it is a demanding surgical procedure involving serious morbidity and risk of surgical complications (14) . Optimal local treatment of recurrence is controversial, with alternative treatments depending on availability of instrumentation and risk, age and comorbidities of the patient (2,15). New treatment modalities with minimally invasive techniques such as percutaneous cryotherapy and thermal ablation, have gained popularity for treatment of men with prostate cancer (2).…”

Does adding local salvage ablation therapy provide survival advantage for patients with locally recurrent prostate cancer following radiotherapy?

“…5,6 sHIFU and sCT have been shown to have a similar comorbidity profile. 7 Whilst there are reports on comparing oncological outcomes with ablation technique versus salvage prostatectomy, 8 there are no reports with local salvage treatment versus those without salvage therapy (NST). Herein, we performed a propensity-score matched analysis with a large multi-institutional radiation therapy database (where patients received standard of care but did not have salvage local prostate treatment) compared with a prospective singleinstitution database on salvage local ablative therapies, to examine for differences in cancer specific survival (CSS) and overall survival (OS).…”

Prostate Cancer – Local Treatment after Radiorecurrence: HIFU – High-Intensity Focused Ultrasound

“…Another larger study reported urethral stricture in 5.5%, a bladder-outlet obstruction requiring transurethral resection (TURP) in about 4% and the necessity of sling or artificial urinary sphincter (AUS) placement due to urinary incontinence in almost 3%. Related to the performed technique, perineal pain is a possible problematic complication of cryotherapy occurring in up to 8% ( 9 ).…”

“…Currently, there are three commercially available devices (Sonablate – Focus Surgery Inc., Ablatherm – EDAP-TMS SA and Focal One – EDAP-TMS SA). It uses a transrectal piezoelectric ceramic transducer focusing on the target that causes thermal, mechanical and cavitation effects, producing a coagulative necrosis in the prostate ( 9 ). Temperatures achieved are above 80°C and there are safety features like a cooling system maintaining rectal mucosa at lower temperatures, a real time 7.5 Mhz.…”