Abstract
Patients with localized prostate cancer (PCa) are often treated with radical prostatectomy (RP). However, more than 30% of such patients have high risk of recurrence. Salvage radiotherapy (SRT), androgen deprivation therapy (ADT) and combination of radiotherapy and ADT are the standard care for recurrent PCa. Recently, high intensity focused ultrasound (HIFU) has gradually applied in the treatment of recurrent PCa. Here, we proposed a hypothesis that combined HIFU and bicalutamide 150mg as first line salvage therapy to treat patients with local recurrent PCa with visible lesions due to the following advantages: (1) HIFU is effective in reducing local tumor load, and bicalutamide 150mg is a feasible and safety option to combine with HIFU. (2) Compared with radiotherapy, HIFU plus 150mg bicalutamide is minimal invasiveness with fewer adverse effects and better quality of life(QOL); (3) Radiotherapy can be preserved as the second-line salvage method in the cases who are failure to HIFU and 150mg bicalutamide combination. More clinical trials are warranted to confirm this hypothesis in treatment with recurrent PCa.
Highlights
Specialty section: This article was submitted to Genitourinary Oncology, a section of the journal Frontiers in Oncology
We proposed a hypothesis that combined high intensity focused ultrasound (HIFU) and bicalutamide 150mg as first line salvage therapy to treat patients with local recurrent prostate cancer (PCa) with visible lesions due to the following advantages: [1] HIFU is effective in reducing local tumor load, and bicalutamide 150mg is a feasible and safety option to combine with HIFU. [2] Compared with radiotherapy, HIFU plus 150mg bicalutamide is minimal invasiveness with fewer adverse effects and better quality of life(QOL); [3] Radiotherapy can be preserved as the second-line salvage method in the cases who are failure to HIFU and 150mg bicalutamide combination
When HIFU is used for the treatment of PCa, it needs to place a high-power probe in the rectum or urethra to generate acoustic energy focused on the tissue target, which non- ablates tissue through hyperthermia and mechanical effect [10,11,12]
Summary
The National Comprehensive Cancer Network (NCCN) published the guideline in 2019 that recommended level 1 evidence supporting 150 mg of bicalutamide daily with radiotherapy combined for two years to treat recurrent PCa [9]. These therapies have some adverse effects that may influence the patient’s quality of life (QOL), such as radiation enteritis and cystitis, rectal bleeding, rectal or anal stenosis, and sexual dysfunction. To further avoid these side effects without reducing patient survival benefits, we postulate that high intensity focused ultrasound (HIFU) combined with Bicalutamide 150mg may be another safe and effective treatment option for local recurrent PCa in carefully selected patients with: [1] Visible lesions on imaging; [2] Patients who cannot tolerate the side effects of radiotherapy or refuse to receive radiotherapy
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