Abstract
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. For salvage HIFU therapy, further research and additional follow-up are required to evaluate and correct the diagnosis of recurrence areas and to provide the sufficient sonication.
Highlights
For the past quarter-century, with the high incidence of prostate cancer worldwide, the proportion of early stage prostate cancer has increased
Salvage radiotherapy has been used as the treatment for patients with local recurrence after radical prostatectomy
Material and methods: Sixteen patients with suspected local recurrence of a vesicourethral anastomosis (VUA) after prostatectomy were treated with high-intensity focused ultrasound (HIFU)
Summary
For the past quarter-century, with the high incidence of prostate cancer worldwide, the proportion of early stage prostate cancer has increased. Since 2003, we have performed transrectal HIFU therapy for patients with localized prostate cancer, and we have reported the efficacy and safety of HIFU ablation for patients with localized prostate cancer [11] [12] According to these experiences, we think HIFU therapy has the advantages of fewer complications, the potential for a repeat treatment, simplicity of the procedure, and shorter treatment times [11]. Salvage radiotherapy has been used as the treatment for patients with local recurrence after radical prostatectomy. 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.
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