Salvage HIFU for recurrent prostate cancer after radiotherapy

Abstract

Recurrent disease following primary radiotherapy for localized prostate cancer is a common problem, occurring in up to 46% of patients. For these patients, therapeutic options include salvage prostatectomy, salvage cryotherapy, salvage high-intensity focused ultrasound (HIFU), hormonal therapy or observation. This review will focus on the emerging evidence for salvage HIFU. There are no randomized or prospective studies in this area. Efficacy results of 17-57% have been reported from retrospective case series, with reported toxicity including rectal fistula in 0-16%, and incontinence in 10-50%. The ideal patient, while yet to be clearly defined, should have preradiotherapy low or intermediate risk disease. Salvage HIFU appears most appropriate for those patients with histologically proven local recurrence only, with a life expectancy of at least 5 years and with some medical comorbidities rendering them not ideal for salvage prostatectomy.

Transrectal high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer: review of technical incidents and morbidity after 5 years of use

“…The 10 patients with localized prostate cancer who had undergone previous radiotherapy were excluded from the calculation to avoid bias. 10,11 In all, 15 patients (36.4%) experienced 20 early complications and 7 patients (12.7%) experienced 7 late complications. Overall, 27 treatment-related side effects were reported in 55 patients (49%).…”

Assessment of histopathological features of needle biopsy in recurrent prostate cancer following salvage high-intensity focused ultrasound

“…11,12 To date, only a few series of salvage HIFU following radiation therapy have been reported in the literature. Table 3 illustrates the functional and oncological outcomes of the recent studies, albeit with relatively short followup.…”

“…11,12 Patients' recruitment for the study was closed in 2010, whereas the followup continues as part of the prospective protocol. Screening for metastatic disease with radio-nucleotide bone scan, abdominal and pelvic computed tomography (CT) was conducted in all cases, in order to exclude patients with extraprostatic disease, who were then deemed ineligible for s-HIFU.…”

“…The presence of residual cancer and high-grade prostatic intraepithelial neoplasia (PIN) was recorded and Gleason grading was performed according to the established Gleason criteria. 12 The morphological features of the non-tumoural prostatic tissue were also examined. Immunohistochemical stains for a-methylacyl-CoA racemase (AMACR), p63, and high-molecular-weight cytokeratin (34-E12) were performed in selected cases on formalinfixed paraffin embedded tissue to confirm the diagnosis of PCa.…”

Comparative morbidity of ablative energy-based salvage treatments for radio-recurrent prostate cancer

“…2 Energy-based salvage treatment modalities, such as high-intensity focused ultrasound (HIFU) and cryotherapy (CRYO), are minimally invasive ablative options which have a more favourable side effect profile. [3][4][5] At our centre we have been treating radio-recurrent prostate cancer (RRPC) with both these energy-based modalities, transitioning from CRYO to HIFU. [6][7][8][9] We report our single centre and single surgeon (17 years) experience to highlight the learning curve and compare the morbidity of the two salvage treatment modalities.…”