High-intensity Focused Ultrasound Failure Research Articles

Salvage radiotherapy following HiFU: An institutional series and literature review.

Algorithms for the treatment of prostate cancer (PrCa) rely on risk grouping, and those who fall into low (LR) and favourable intermediate risk (FIR) categories have multiple options for treatment. High-intensity focused ultrasound (HiFU) is a local treatment modality that uses ultrasound waves to ablate prostate cancer. In case of treatment failure, optimal salvage modality after HiFU remains unclear. Here, we describe a retrospective review of our regional cancer database for men who underwent salvage radiotherapy after failure of HiFU treatment for prostate cancer. Oncologic and toxicity outcomes of the men identified in our database are discussed. We identified 14 men in our regional database who received salvage radiotherapy (70-74 Gy with or without androgen deprivation therapy (ADT) after primary HiFU, in the period of 2009-2017. No cases of any grade 3 or higher toxicity were observed. In our cohort, 50% (7/14) of patients developed secondary biochemical failure at a median follow-up of 54 months post-radiotherapy, with a mean time to biochemical failure of 39 months. We compare our data to other available reports to date consisting mostly of small, non-randomized studies. Our biochemical control rates are noticeably lower compared with those reported by other studies but our length of follow-up is longer, compared with other studies. The available data to date suggest that salvage radiotherapy after HiFU failure is well-tolerated albeit with only modest efficacy.

High-intensity focused ultrasound for the treatment of prostate cancer: assessing location of failure after focal therapy in prostate cancer and review of histological characteristics and clinicopathologic correlates after treatment—a 5-year experience

High-intensity focused ultrasound (HIFU) is a noninvasive treatment option used for localized prostate cancer or salvage surgery after failed radiation therapy. Histological changes in post-treatment needle biopsies are reviewed to better understand HIFU failures. Between 2016 and 2021, 50 patients with localized prostate cancer were enrolled and treated in this study. Of these, 10 patients underwent salvage therapy after radiation failure and 7 did not have post-treatment needle biopsies available for review and were excluded. Inclusion criteria included pathologically confirmed prostate cancer and clinical stage T1/T2 disease. We describe the histological changes in post-treatment needle biopsies as part of routine follow-up. Biopsies were examined for presence, distribution and extent of residual adenocarcinoma, Gleason score, and ablative tissue changes. A total of 33 patients underwent HIFU hemi-ablation treatment of localized prostate cancer as primary treatment with post-treatment biopsies available for review. The average mean age of the patients was 64 years (range, 52-81 years). The average PSA (prostate-specific antigen) level of the patients was 6.3ng/mL (range, 2.4-14.7ng/mL). The Gleason scores assigned in pretreatment prostate needle biopsies are as follows: 3 + 3 (1 case, 3%), 3 + 4 (21 cases, 64%), 4 + 3 (9 cases, 27%), and 4 + 4 (2 cases, 6%). In post-treatment needle biopsies, 33 cases (100%) showed variable degrees of fibrosis ranging from mild to moderate. Twenty-four of 33 cases (73%) showed necrosis usually associated with acute and/or chronic inflammation. Histological examination of benign glands revealed glandular heterogeneity including atrophy and basal cell hyperplasia. Eight cases (24%) had residual prostatic adenocarcinoma after treatment, of which 4 cases were assigned Gleason score: ≥3+4. In cases with residual adenocarcinoma, 8 cases (100%) showed nuclear enlargement, 5 cases (63%), cytoplasmic vacuolization, and 1 case (13%) showed nuclear pyknosis; otherwise, no discernible effects of treatment were seen. Morphological alterations included a spectrum of changes ranging from extensive coagulative stromal necrosis secondary to thermal injury to atrophic changes in benign prostatic tissue after HIFU treatment. Our findings also support the hypothesis that HIFU failure results from inadequate targeting rather than failure within a treated zone.

Salvage External Beam Radiotherapy After HIFU Failure in Localized Prostate Cancer: A Single Institution Experience

<h3>Purpose/Objective(s)</h3> Standard treatment options for localized prostate cancer include active surveillance, radical prostatectomy, or local radiotherapy. While the use of high-intensity focused ultrasound (HIFU) as a primary treatment remains investigational, it is sometimes offered to select patients. At the time of HIFU failure, there is a lack of data in salvage treatment approach. Available data includes only small retrospective series with short-term follow-up. We therefore sought to evaluate our institutional experience in a cohort of patients treated with salvage radiation therapy (SRT) after primary HIFU failure. <h3>Materials/Methods</h3> We conducted a retrospective analysis of patients who had local failure after HIFU. This cohort of patients received salvage external beam radiation therapy (EBRT) delivered via intensity modulated radiotherapy (IMRT). Our primary endpoint was biochemical failure-free survival (bFFS) based on the 'Phoenix' definition of PSA nadir + 2 ng/mL. Secondary endpoints included metastasis-free survival (MFS) and overall survival (OS). Kaplan-Meier analysis was performed examining bFFS, MFS and OS. Genitourinary and erectile dysfunction adverse events were analyzed. <h3>Results</h3> From 2010 to 2018, 12 patients had local relapse post primary HIFU and received salvage EBRT with or without androgen-deprivation therapy, 75% and 25% respectively. The mean initial PSA prior to salvage EBRT was 8.2ug/L (2.9-14.4ug/L). The median time from HIFU to salvage EBRT was 13.5 months (6-42 months). EBRT was delivered as either conventional (76-78 Gy in 38-39 fractions, n = 11) or hypofractionation (66 Gy in 22 fractions, n = 1). Mean PSA nadir post RT was 1.2ug/L (0.1-2.6 ug/L). Acute International Prostate Symptom Score (IPSS) as well as International Index of Erectile Dysfunction (IIEF) scores were similar to baseline (<i>P</i> = 0.5 and 0.1, respectively). Late toxicities were comparable to those reported in men receiving EBRT as their primary treatment for localized prostate cancer. At a median follow-up of 46 months, only one patient had biochemical recurrence and radiological progression. The 5-year bFFS and MFS were both 83.3%. There were no deaths at the time of this analysis (OS = 100%). <h3>Conclusion</h3> To our knowledge this is one of the largest series reporting on modern SRT post HIFU failure. Our analysis shows that salvage EBRT is feasible, effective and carries no additional acute and delayed toxicity.

Post-HIFU locally relapsed prostate cancer: high-dose salvage radiotherapy guided by molecular imaging

To evaluate tolerance and biochemical control rates of salvage external beam radiotherapy (EBRT) in patients with local relapse from prostate cancer (PC) after high-intensity focused ultrasound (HIFU) as primary treatment. Twenty-four patients presented biochemical failure of PC. Salvage EBRT to the residual prostate was performed with moderate hypofractionation schedule (MHRT) in 28 fractions (n = 16) or with extreme hypofractionation schedule (SBRT) in 5 fractions (n = 8) by means of image-guided volumetric modulation arc therapy. In case of MHRT, the median dose was 71.4Gy, whereas in case of SBRT it was 32.5Gy. The median follow-up was 28months. The median PSA nadir was 0.26ng/mL. In case of MHRT, the median PSA nadir was 0.15ng/mL and occurred within a median time of 19months. In case of SBRT, the median PSA nadir was 0.64ng/mL and occurred within a median time of 8months. No G3 higher acute or late toxicity after EBRT was observed. Only three patients presented with G2 acute GI toxicity (actinic proctitis). Twelve patients experienced acute G1 GU toxicity: 8/16 of men treated with MHRT and 4/8 of men treated with SBRT. Complete local control of disease was achieved in 23/24 patients (96%). Our data confirm the feasibility and the low toxicity of salvage EBRT with both schedules of treatment after HIFU failure. The findings of low acute toxicity and good biochemical control rates are encouraging, but a larger number of patients and a longer follow-up are needed to confirm these results.

MP18-06 SALVAGE EXTERNAL BEAM RADIATION THERAPY (EBRT) FOR LOCAL RECURRENCE AFTER HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) FAILURE VERSUS SALVAGE HIFU FOR LOCAL RECURRENCE AFTER EBRT FAILURE: A MATCHED PAIR COMPARISON

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy1 Apr 2016MP18-06 SALVAGE EXTERNAL BEAM RADIATION THERAPY (EBRT) FOR LOCAL RECURRENCE AFTER HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) FAILURE VERSUS SALVAGE HIFU FOR LOCAL RECURRENCE AFTER EBRT FAILURE: A MATCHED PAIR COMPARISON Ji-Wann Lee, Albert Gelet, Jeremy Soria, Marc Colombel, Pascal Pommier, Christelle Melodelima, Olivier Rouviere, Lionel Badet, and Sebastien Crouzet Ji-Wann LeeJi-Wann Lee More articles by this author , Albert GeletAlbert Gelet More articles by this author , Jeremy SoriaJeremy Soria More articles by this author , Marc ColombelMarc Colombel More articles by this author , Pascal PommierPascal Pommier More articles by this author , Christelle MelodelimaChristelle Melodelima More articles by this author , Olivier RouviereOlivier Rouviere More articles by this author , Lionel BadetLionel Badet More articles by this author , and Sebastien CrouzetSebastien Crouzet More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2707AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES EBRT is one of the gold standard treatments for localized prostate cancer. High Intensity Focused Ultrasound (HIFU) is a new minimally invasive treatment option with promising outcomes. HIFU is one of salvage option after EBRT failure and EBRT is the standard salvage option for local relapse after HIFU. No randomized study is available to compare these two strategies of salvage treatment after a first line therapy. The goal was to evaluate the oncologic outcomes by using a matched pair analysis to compare patients treated with HIFU first + salvage EBRT (S-EBRT) versus EBRT first + salvage HIFU (S-HIFU) METHODS This retrospective study was designed to overcome limitations of case series studies by using a matched pair design in patients treated contemporaneously with salvage HIFU and salvage EBRT in the same institution between 1994 and 2014. Cancer specific free survival rate were the primary endpoints. Secondary endpoints were metastasis free survival rate, and survival rate without salvage androgen deprivation therapy (S-ADT). The progression free survival rates were calculated with Kaplan-Meier estimate RESULTS A total of 480 patients received S-HIFU for EBRT failure and 370 received S-EBRT for HIFU failure. Those 850 patients were prospectively followed and matched to a 1:1 basis following known prognostic variables: PSA level, Gleason score and d’Amico risk classification. A perfect match was obtained for 342 patients (171 in each group). The mean age was significantly lower in the EBRT: 65.26±5.87 years versus 68.82±5.41 years (p:<0.001). In the EBRT first group the mean dose was 71.02±3.74 Grays. The delay between EBRT and salvage HIFU was 5.07±2.4 months. The mean PSA value before salvage HIFU was 4.73±3.68ng/ml and the Gleason score of the recurrence was =6 in 36.16% of patients, 7 in 30.99 % and =8 in in 32.75 %. In the HIFU first group the mean number of HIFU sessions was 1.58±053 per patient, the mean delay between HIFU and S-EBRT was 3.11±2.35 months, the mean PSA value before S-EBRT was 3.03±2.84 ng and the Gleason score of the recurrence was =6 in 60.23% of patients, 7 in 27.49% and =8 in 12.28%. The cancer specific free survival rate at 60 and 120 months was significantly better (log rank test, p:0.035) after HIFU+S-EBRT than after EBRT+S-HIFU (99.4% and 94.8% versus 93.1% and 83.7% respectively). The metastatic free survival rate at 60 and 120 months was significantly better (log rank test, p< 0.001) after HIFU+S-EBRT than after EBRT+S-HIFU (95.3% and 85% versus 85.2 % and 69.4% respectively). The palliative androgen deprivation free rate at 60 months was also significantly different (Log rank test, p<0.001) after HIFU+S-EBRT than after EBRT+S-HIFU (84.7% versus 40.7%). However, the delay between the first treatment and the salvage therapy was longer in the EBRT+S-HIFU group CONCLUSIONS In our department, the cancer specific survival rate, the metastatic free survival rate and the palliative androgen deprivation free rate was significantly better in the HIFU+S-EBRT group than in the EBRT+S-HIFU group in a matched pair comparison © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e194 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ji-Wann Lee More articles by this author Albert Gelet More articles by this author Jeremy Soria More articles by this author Marc Colombel More articles by this author Pascal Pommier More articles by this author Christelle Melodelima More articles by this author Olivier Rouviere More articles by this author Lionel Badet More articles by this author Sebastien Crouzet More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Proton Therapy as Salvage Treatment for Local Relapse of Prostate Cancer Following Cryosurgery or High-Intensity Focused Ultrasound

Local recurrence of prostate cancer after cryosurgery (CS) and high-intensity focused ultrasound (HIFU) is an emerging problem for which optimal management is unknown. Proton therapy (PT) may offer advantages over other local therapeutic options. This article reviews a single institution's experience using PT for salvage of local recurrent disease after HIFU or CS. We reviewed the medical records of 21 consecutive patients treated with salvage PT following a local recurrence of prostate cancer after CS (n=12) or HIFU (n=9) between January 2007 and July 2014. Patients were treated to a median dose of 74 Gy(relative biological effectiveness [RBE]; range: 74-82 Gy[RBE]) and 8 patients received androgen deprivation therapy with radiation therapy. Patients were evaluated for quality of life (QOL) by using the Expanded Prostate Index Composite questionnaire and toxicity by using Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment, every 6 months for 2 years after treatment, and then annually. Median follow-up was 37 months (range: 6-95 months). The 3-year biochemical progression-free survival (bPFS) rate was 77%. The 3-year grade 3 toxicity rate was 17%; however, 2 of these patients had pre-existing grade 3 GU toxicities from their HIFU/CRYO prior to PT. At 1 year, bowel summary, urinary incontinence, and urinary obstructive QOL scores declined, but only the bowel QOL score at 12 months met the minimally important difference threshold. PT achieved a high rate of bPFS with acceptable toxicity and minimal changes in QOL scores compared with baseline pre-PT functions. Although most patients have done fairly well, the study size is small, follow-up is short, and early results suggest that outcomes with PT for salvage after HIFU or CS failure are inferior to outcomes with PT given in the de novo setting with respect to disease control, toxicity, and QOL.

PD47-05 PROSPECTIVE COMPARISON OF ONCOLOGICAL OUTCOMES BETWEEN FOCAL CRYOTHERAPY VERSUS FOCAL HIGH-INTENSITY FOCUSED ULTRASOUND IN LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized VII1 Apr 2015PD47-05 PROSPECTIVE COMPARISON OF ONCOLOGICAL OUTCOMES BETWEEN FOCAL CRYOTHERAPY VERSUS FOCAL HIGH-INTENSITY FOCUSED ULTRASOUND IN LOCALIZED PROSTATE CANCER Youness Ahallal, Eric Barret, Rafael Sanchez-Salas, Marc Galiano, Francois Rozet, and Xavier Cathelineau Youness AhallalYouness Ahallal More articles by this author , Eric BarretEric Barret More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Marc GalianoMarc Galiano More articles by this author , Francois RozetFrancois Rozet More articles by this author , and Xavier CathelineauXavier Cathelineau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2749AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare the oncological outcomes of focal cryotherapy with those of focal High-Intensity Focused Ultrasound (HIFU) in patients with localized prostate cancer. METHODS Between 2009 and 2014, 277 patients harboring localized prostate cancer were treated with FT. Of these 277; 149 prospective patients with at least one-year follow-up were included for analysis. The median serum PSA before primary therapy was 6.4 ng/ml (Interquartilrange [IQR]: 3.3-8.6) and 6.2 ng/ml (IQR: 3.5- 8.9) in patients treated with focal cryotherapy and focal HIFU respectively. Clinical stage before focal cryotherapy and focal HIFU was T1C in 78 and 48 patients and T2A in 13 and 10, respectively. Biopsy Gleason score in patients treated with focal cryotherapy and focal HIFU before primary therapy was 6 (3+3) in 75 and 53 patients, 7 (3+4) in 16 and 5 patients; respectively; and 1 patient with a Gleason Score of 7(4+3) was treated with focal cryotherapy. The median serum PSA nadir after focal cryotherapy was 2.9 ng/ml (IQR: 0.5-5.30) and 3.6 ng/ml (IQR: 0.9-6.3) for patients treated with focal HIFU (p=0.18). Treatment failure was defined as any positive control biopsy. Salvage treatment was introduced in case of treatment failure: FT is therefore reconsidered if only one biopsy is positive in the same lobe; otherwise, the patient is offered AS, androgen deprivation therapy (ADT) or salvage robotic-assisted radical prostatectomy (sRARP). RESULTS After 22 (IQR: 12-28) and 19 (12-24) months median follow-up, 43 (47%) and 18 (31%) patients had positive biopsies for cancer (p=0.12): 14 (15.4%) and 8 (13.8%) ipsilateral, 14 (15.4%) and 7 (12.1%) contralateral lobe; and, 15 (16.5%) and 3 (5.2%) bilateral in patients treated with focal cryotherapy and focal HIFU, respectively. In patients treated with focal cryotherapy and focal HIFU, 15 and 4 had Gleason 7 positive control biopsy, respectively; they had therefore salvage radical proatatectomy. 13 and 3 patients had 1 ipsilateral Gleason 6 positive biopsy in patients treated with focal cryotherapy and focal HIFU respectively, out of whom, 9 underwent repeat FT and 7 chose AS. CONCLUSIONS Focal cryotherapy and focal HIFU failure rates were not statistically significant featuring comparable oncological outcomes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e963 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Youness Ahallal More articles by this author Eric Barret More articles by this author Rafael Sanchez-Salas More articles by this author Marc Galiano More articles by this author Francois Rozet More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Salvage high-intensity focused ultrasound ablation for prostate cancer local recurrence after external-beam radiation therapy: Prognostic value of prostate MRI

To assess the prognostic value of magnetic resonance imaging (MRI) before salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after external-beam radiotherapy (EBRT). Forty-six patients who underwent prostate MRI before salvage HIFU for locally recurrent prostate cancer after EBRT were retrospectively studied. HIFU failure was defined as a prostate-specific antigen (PSA) value >nadir + 2 ng/ml (Phoenix criteria) or positive follow-up biopsy or initiation of any other salvage therapy. The following prognostic parameters were assessed: neoadjuvant hormone therapy, clinical stage and Gleason score of recurrence, PSA level and velocity at HIFU treatment, and six MRI-derived parameters (prostate volume, tumour volume, extracapsular extension, seminal vesicle invasion, tumour extension into the apex or anterior to the urethra). Two factors were significant independent predictors of salvage HIFU failure: the PSA level at HIFU treatment (p < 0.012; risk ratio: 1.15, 95% CI: 1.03-1.29) and the tumour extension anterior to the urethra, as assessed by MRI (p = 0.046, risk ratio: 2.51, 95% CI: 1.02-6.16). The location of cancer recurrence anterior to the urethra on MRI is an independent significant predictor of salvage HIFU failure for locally recurrent prostate cancer after EBRT. Therefore, MRI may be useful for patient selection before post-EBRT salvage HIFU ablation.

Salvage External Beam Radiotherapy for Recurrent Prostate Adenocarcinoma after High-Intensity Focused Ultrasound as Primary Treatment

Introduction: The main objective was to evaluate feasibility, toxicity and biochemical control rates of salvage external beam radiotherapy (EBRT) in recurrent localized prostate cancer after high-intensity focused ultrasound (HIFU) as primary therapy. Patients and Methods: A total of 24 patients who underwent salvage EBRT after 1 or 2 HIFU sessions and with a minimum post-treatment follow-up of 24 months were retrospectively evaluated. Primary endpoints were toxicity and biochemical disease-free survival (bDFS, defined according to the ASTRO Phoenix definition). Results: Median follow-up was 40.3 months. Gastrointestinal toxicity was low. Acute genitourinary (GU) toxicity grade ≤II rate was 45.8%, with only few patients presenting grade III (8.3%) and grade IV (4.2%) toxicity. Late grade ≥III GU toxicity was registered in 16.7% of patients. The 3-year bDFS rate was 77.8%. Patients achieving a nadir prostate-specific antigen (nPSA) of ≤0.35 ng/ml after EBRT had significantly higher bDFS (3-year bDFS: 87.7 vs. 50%, respectively; p = 0.001). Achieving nPSA ≤0.35 ng/ml was the only factor independently associated to long-term bDFS both on univariate (p = 0.01) and multivariate analysis (HR 7.06, p = 0.039). Conclusions: Salvage EBRT after HIFU failure is feasible and allows to obtain satisfactory biochemical control rates, especially in patients attaining a nPSA ≤0.35 ng/ml after EBRT.

11C Choline PET Guided Salvage Radiotherapy with Volumetric Modulation Arc Therapy and Hypofractionation for Recurrent Prostate Cancer after HIFU Failure: Preliminary Results of Tolerability and Acute Toxicity

The purpose of this work was to evaluate tolerance, feasibility and acute toxicity in patients undergoing salvage radiotherapy after high-intensity focused ultrasound (HIFU) failure. From 2005 to 2011 a total of 15 patients were treated with HIFU as primary radical treatment. Between July 2011 and February 2013, all 15 patients presented biochemical relapse after HIFU and 11C choline PET documenting intrapostatic-only failure. Salvage EBRT was performed with moderate hypofractionation schedule in 28 fractions with volumetric modulation arc therapy (VMAT). Genito-urinary (GU) and rectal and bowel toxicity were scored by common terminology criteria for adverse events version 4 (CTCAE V.4) scale. Biochemical response was assessed by ASTRO Phoenix criteria. Median age of patients was 67 years (range: 53-85). The median Gleason score was 7 (range: 6-9). The median prostate specific antigen (PSA) at the time of biochemical relapse after HIFU was 5.2 ng/mL (range: 2-64.2). Seven of the 15 patients received androgen deprivation therapy (ADT) started after HIFU failure, interrupted before 11C choline PET and radiotherapy. Median prescribed dose was 71.4 Gy (range: 71.4-74.2 Gy) in 28 fractions. No radiation related major upper gastrointestinal (GI), rectal and GU toxicity were experienced. GU, acute grade 1 and grade 2 toxicities were recorded in 7/15 and 4/15 respectively; bowel acute grade 1 and grade 2 toxicities in 4/15 and 1/15; rectal acute grade 1 and grade 2 toxicities in 3/15 and 2/15 respectively. No grade 3 or greater acute or late toxicities occurred. Biochemical control was assessed in 12/15 (80%) patients. With a median follow up of 12 months, three out of 15 patients, with biochemical relapse, showed lymph-nodal recurrence. Our early clinical results and biochemical data confirm the feasibility and show a good tolerance of the 11C choline PET guided salvage radiation therapy after HIFU failure. The findings of low acute toxicity is encouraging, but longer follow-up is needed to assess late toxicity and definitive outcomes.

Salvage radiotherapy after high-intensity focused ultrasound treatment for localized prostate cancer: feasibility, tolerance and efficacy

Background: The objective of this study is to evaluate the feasibility,tolerance and efficacy of salvage external beam radiotherapy(EBRT) in persistent or recurrent prostate cancer after failed highintensity focused ultrasound (HIFU) therapy.Methods: We reviewed data on tolerance and oncologic outcomesfor all patients with biopsy-proven locally recurrent or persistentprostate cancer who underwent salvage EBRT in our departmentbetween April 2004 and June 2008. Minimum follow-up for inclusionwas 2 years. Failure with EBRT was defined as biochemicalrelapse (Phoenix definition) or introduction of androgen deprivationtherapy (ADT). Gastrointestinal and urinary toxicity and urinary stressincontinence were scored at 12 and 24 months (Radiation TherapyOncology Group and Ingelman Sundberg rating, respectively).Results: The mean age of the patients was 68.8 years (range: 60-79).Mean prostate-specific antigen (PSA) before EBRT was 5.57 ng/mL(range: 2.5-14.8). Median follow-up was 36.5 ± 10.9 months(range: 24-54). No patient received adjunctive ADT. The EBRTcourse was well-tolerated and completed by all patients. The meanPSA nadir was 0.62 ng/mL (range: 0.03-2.4) and occurred after amedian of 22 months (range: 12-36). One patient experiencedbiochemical failure and was prescribed ADT 30 months after EBRT.The disease-free survival rate was 83.3% at 36.5 months. Therewas no major EBRT-related toxicity at 12 or 24 months.Conclusions: Our early clinical results confirm the feasibilityand good tolerance of salvage radiotherapy after HIFU failure.Oncological outcomes were promising. A prospective study withlonger follow-up is needed to identify factors predictive of successfor salvage EBRT therapy after HIFU failure.

HIFU: Definitely ready for prime time

HIFU: Definitely ready for prime time

HIFU ablation is not a proven standard treatment for localized prostate cancer.

HIFU ablation is not a proven standard treatment for localized prostate cancer.

Salvage radiotherapy after high-intensity focused ultrasound treatment for localized prostate cancer: feasibility, tolerance and efficacy.

The objective of this study is to evaluate the feasibility, tolerance and efficacy of salvage external beam radiotherapy (EBRT) in persistent or recurrent prostate cancer after failed high intensity focused ultrasound (HIFU) therapy. We reviewed data on tolerance and oncologic outcomes for all patients with biopsy-proven locally recurrent or persistent prostate cancer who underwent salvage EBRT in our department between April 2004 and June 2008. Minimum follow-up for inclusion was 2 years. Failure with EBRT was defined as biochemical relapse (Phoenix definition) or introduction of androgen deprivation therapy (ADT). Gastrointestinal and urinary toxicity and urinary stress incontinence were scored at 12 and 24 months (Radiation Therapy Oncology Group and Ingelman Sundberg rating, respectively). The mean age of the patients was 68.8 years (range: 60-79). Mean prostate-specific antigen (PSA) before EBRT was 5.57 ng/mL (range: 2.5-14.8). Median follow-up was 36.5 ± 10.9 months (range: 24-54). No patient received adjunctive ADT. The EBRT course was well-tolerated and completed by all patients. The mean PSA nadir was 0.62 ng/mL (range: 0.03-2.4) and occurred after a median of 22 months (range: 12-36). One patient experienced biochemical failure and was prescribed ADT 30 months after EBRT. The disease-free survival rate was 83.3% at 36.5 months. There was no major EBRT-related toxicity at 12 or 24 months. Our early clinical results confirm the feasibility and good tolerance of salvage radiotherapy after HIFU failure. Oncological outcomes were promising. A prospective study with longer follow-up is needed to identify factors predictive of success for salvage EBRT therapy after HIFU failure.

High-intensity focused ultrasound therapy for clinically localized prostate cancer

The efficacy of high-intensity focused ultrasound (HIFU) used for the treatment of localized prostate cancers has been demonstrated over the past decade. We present our early results after HIFU used as a single session in patients with clinically localized prostate cancer. A total of 58 patients were treated using the Ablatherm HIFU device with or without transurethral resection of the prostate (TURP). HIFU failure was defined as the presence of a cancer remnant on repeated biopsies or three consecutive increases in the prostate-specific antigen (PSA) >/=1.0 ng/ml. The mean follow-up was 14 months (range, 6-21 months). After HIFU treatment, 78% of patients had a decreased PSA level to <0.5 ng/ml within 3 months. The median value of the last PSA was 0.6 ng/ml and the median nadir PSA was 0.2 ng/ml. The success rates of HIFU were 85, 77 and 47% in low-, intermediate- and high-risk groups, respectively. The HIFU failure rate was closely associated with clinical stage, presence of cancer on TURP chips and nadir PSA on univariate analysis. However, the only significant predictor for HIFU failure was the nadir PSA value by multivariate Cox regression analysis. The operation-related complications were minimal. Although both the period and number of patients were limited to evaluate the clinical efficacy, HIFU appears to be a safe and effective treatment option in selected patients with prostate cancer.