Local Recurrence Of Prostate Cancer Research Articles

High‐intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after external beam radiation, brachytherapy or proton therapy

To investigate the use of high-intensity focused ultrasound (HIFU) as a salvage therapy in patients with recurrence of localized prostate cancer after external beam radiation (EBRT), brachytherapy, or proton therapy. We retrospectively reviewed the charts of all patients who had undergone salvage HIFU for biopsy-proven prostate cancer after primary radiation therapy. Patient characteristics and oncological outcomes were assessed. Records of 22 patients with a median (range) follow-up of 24 (5-80) months were reviewed. Patients were men with presumed organ-confined disease who had been treated with salvage HIFU following recurrent disease after EBRT (fourteen patients), brachytherapy (five patients: four with high-dose brachytherapy using In(192) ; and one with low-dose brachytherapy using Au(98) ) or proton therapy (three patients). The median (range) age at salvage HIFU was 65 (52-80) years, with a median (range) prostate-specific antigen (PSA) level before radiation therapy of 14.3 (5.7-118) ng/mL and a median (range) PSA level of 4.0 (1.2-30.1) ng/mL before HIFU. The median (range) period to HIFU after radiation therapy was 36 (4-96) months. The biochemical disease-free survival (bDFS) rate in all patients at 5 years was 52%. Rates of bDFS in low-, intermediate- and high-risk groups were 100%, 86%, and 14%, respectively. One of the twelve patients who received post-HIFU prostate biopsy showed malignancy. Side effects included urethral stricture in four patients, grade I urinary incontinence in four patients, rectourethral fistula and epididymitis in one of each patient. Salvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment.

Locally Recurrent Prostate Cancer after External Beam Radiation Therapy: Diagnostic Performance of 1.5-T Endorectal MR Imaging and MR Spectroscopic Imaging for Detection

To determine if performing magnetic resonance (MR) spectroscopic imaging, compared with performing T2-weighted MR imaging alone, improves the detection of locally recurrent prostate cancer after definitive external beam radiation therapy. This retrospective single-institution study was approved by the committee on human research, with a waiver of informed consent, and was compliant with HIPAA requirements. Sixty-four men who underwent endorectal MR imaging, MR spectroscopic imaging, and transrectal ultrasonographically guided biopsy for suspected local recurrence of prostate cancer after definitive external beam radiation therapy were retrospectively identified. Thirty-three patients had also received androgen therapy. Recurrent cancer was determined to be present or absent in the left and right sides of the prostate at T2-weighted MR imaging and MR spectroscopic imaging by a radiologist and a spectroscopist, respectively. Area under the receiver operating characteristic curve (A(Z)) was calculated for T2-weighted MR imaging alone and combined T2-weighted MR imaging and MR spectroscopic imaging by using generalized estimating equations and by using biopsy results as the reference standard. Recurrent prostate cancer was identified at biopsy in 37 (58%) of the 64 men. Recurrence was unilateral in 28 patients and bilateral in nine (total of 46 affected prostate sides). A(Z) analysis revealed that use of combined T2-weighted MR imaging and MR spectroscopic imaging (A(Z) = 0.79), as compared with T2-weighted MR imaging alone (A(Z) = 0.67), significantly improved the detection of local recurrence (P = .001). The addition of MR spectroscopic imaging to T2-weighted MR imaging significantly improves the diagnostic accuracy of endorectal MR imaging in the detection of locally recurrent prostate cancer after definitive external beam radiation therapy.

Role of MRI in Follow-Up After Focal Therapy for Prostate Carcinoma

In patients with clinically suspected local recurrence of prostate cancer, a lobulated hyperintense mass in the radical prostatectomy fossa can be readily visualized with T2-weighted MRI, but this imaging technique is less successful after treatments such as radiation therapy, high-intensity focused ultrasound, and cryosurgery. We describe the additional value of functional techniques in the assessment of local recurrence. The use of functional MRI techniques such as MR spectroscopy, diffusion-weighted imaging, and dynamic contrast-enhanced MRI has shown promise in increasing overall imaging performance in the detection of local recurrence.

Salvage high‐intensity focused ultrasound for biopsy‐confirmed local recurrence of prostate cancer after radical prostatectomy

To present experience in high-intensity focused ultrasound (HIFU) used as a salvage therapy for biopsy-confirmed local recurrence at the vesico-urethral anastomosis after radical prostatectomy (RP). From July 2006, four patients diagnosed with prostate cancer recurrence after RP were treated with HIFU, with or without salvage radiotherapy, using the Sonablate 500 (Focus Surgery, IN, USA). Biochemical failure was defined as in increase in prostate-specific antigen (PSA) level of >0.2 ng/mL. No patients received any adjuvant therapy after HIFU therapy before reporting failure. The mean age and initial PSA level before RP was 74 years and 10.0 ng/mL, respectively. After RP, one patient was stage T2aN0M0, two were stage T3N0M0 and the last had an unknown pathological stage. Three patients received external beam radiotherapy as salvage therapy after RP. The mean PSA level before HIFU, tumour volume at the vesico-urethral lesion and operative duration were 4.3 ng/mL, 4.6 mL and 27 min, respectively. Adenocarcinomas were confirmed by biopsy of the tumour at the vesico-urethral anastomotic lesion before HIFU. At 24 months of follow-up, patients 2 and 4 were classified a biochemically disease-free. Biopsies at the anastomotic site after HIFU in three patients showed no malignancy, with fibrosis. There were no complications. Salvage HIFU for patients with recurrence after RP is feasible, even though they received salvage radiotherapy before HIFU. More patients and a longer follow-up are needed to evaluate the safety and oncological adequacy of this new approach.

591 LOW DOSE BRACHYTHERAPY WITH I125 IN PATIENTS WITH LOCAL PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized III1 Apr 2010591 LOW DOSE BRACHYTHERAPY WITH I125 IN PATIENTS WITH LOCAL PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY F.G. Gómez Veiga, A. Marino, I. Gómez, L.A. Castelo, J. Gonzalez Dacal, S. Breijo, D. Lopez, J. Ponce, A. Candal, and V. Chantada F.G. Gómez VeigaF.G. Gómez Veiga More articles by this author , A. MarinoA. Marino More articles by this author , I. GómezI. Gómez More articles by this author , L.A. CasteloL.A. Castelo More articles by this author , J. Gonzalez DacalJ. Gonzalez Dacal More articles by this author , S. BreijoS. Breijo More articles by this author , D. LopezD. Lopez More articles by this author , J. PonceJ. Ponce More articles by this author , A. CandalA. Candal More articles by this author , and V. ChantadaV. Chantada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.863AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment for patients with biochemical progression after radical prostatectomy (RP) and suspicion of local recurrence usually consists of external beam radiotherapy. This a valid option, but not exempt from complications, and is demanding in terms of dose adjustment and definition of target volumes. Low dose- brachytherapy (LDB) is an alternative option for patients with localized prostate cancer. The aim of this prospective study was to analyze the capacity of LDB to treat patients with local progression after RP in terms of toxicity and oncologic control METHODS 42 patients were treated for local prostate cancer relapse from April 2004 to July 2009. Median age was 69.2 years(54-76). The pathologic staging after at RP was 1(2.4%) pT0, 5(11.9%) pT2a, 7(16.7%), pT2b, 14(33.3%)pT2c, 11(26.2%) pT3a and 4(9.5%) pT3b. Local progression in all cases was confirmed by positive biopsy. The Gleason score (GS) on control biopsy ranged from 6-9, 20(47.1%) GS 6, 18(42.9%) GS 7 and 4 (9.5%) GS ≥8. Only patients with more than 6 months follow-up were included n=35. The median follow-up was 29.5 months (6-60.5), and median time to biochemical progression 26 months. Median PSA before LDB was 1.9 ng/mL(range 0.24-6.8). Real-time implant was realized using Variseed 7.2 program and Rapid Strand ®seeds were used. Treatment dose planning was for 144 Gy to cover the anastomotic area. Median volume prescription was 10cc (3.1-23), seeds activity 0.48mci, seeds per session 44.4, and median prostate and urethra d90 174Gy and 121G respectively. All patients were assessed for acute and late gastrointestinal (GI) and genitourinary (GU) toxicity as defined by RTOG. Biochemical failure was defined using the Phoenix definition. All cases were hormone naive prior to LDB. RESULTS Median hospital stay was 21h. There were no major perioperative complications. All patients were discharged without urethral catheter. Acute GI and GU complications grade 1 and 2 were 2(5.7%), 1(2.9%) and 14(40%) and 3(8.6%) respectively.Mild previous incontinence improved in 3 patients (8.6%). Late GI and GU complications grade 1 or 2 were 3 (8.8%), 1 (2.9%), and 3 (8.6%) and 1 (2.9%) respectively. With a median follow up of 29.5 months, biochemical relapsed-free survival was 88.6%, 4 patients had biochemical failure and one patient died, related to prostate cancer the cancer- free survival was 97%. CONCLUSIONS Although longer follow up is needed, these promising results, with minimal morbidity and excellent biochemical response, lead us to believe that LDB is a valid salvage option or patients with local relapse after RP A Coruna, Spain© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e232 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information F.G. Gómez Veiga More articles by this author A. Marino More articles by this author I. Gómez More articles by this author L.A. Castelo More articles by this author J. Gonzalez Dacal More articles by this author S. Breijo More articles by this author D. Lopez More articles by this author J. Ponce More articles by this author A. Candal More articles by this author V. Chantada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A prospective study of salvage high-intensity focused ultrasound for locally radiorecurrent prostate cancer: Early results

After radical external beam radiation therapy (EBRT), local recurrence may benefit from definitive local therapy. The objective of this study was to evaluate the safety and short-term biochemical results and morbidity after salvage high-intensity focused ultrasound (HIFU) treatment in patients with biopsy-proven local prostate cancer recurrence after EBRT. From October 2006 46 patients were treated with HIFU. Bone scan and abdominal CT/MRI scan were negative. Median follow-up was 9 months (range 3-24 months). The median prostate-specific antigen (PSA) nadir was 0.3 ng/ml (range 0-24 ng/ml). Eighteen patients (39.1%) were classified as failures. In addition, there were four patients (8.7%) with post-HIFU PSA nadir > 0.5 ng/ml. No patients died during follow-up. One patient developed urethrorectal fistulae and was successfully treated conservatively. Two patients developed urethrocutaneous fistulae. Seven patients (15.2%) and one patient (2.1%) developed grade 2 and grade 3 incontinence, respectively. Seven men (15.2%) had erectile function sufficient for intercourse pre-HIFU and only two men (4.3%) post-HIFU. Early results of salvage HIFU in patients with local recurrence of prostate cancer after radical EBRT indicate the procedure to be a reasonable treatment option, but better patient selection criteria are needed. The side-effects are not negligible.

Feasibility of 3T Dynamic Contrast-Enhanced Magnetic Resonance-Guided Biopsy in Localizing Local Recurrence of Prostate Cancer After External Beam Radiation Therapy

The objective of this study was to assess the feasibility of the combination of magnetic resonance (MR)-guided biopsy (MRGB) and diagnostic 3T MR imaging in the localization of local recurrence of prostate cancer (PCa) after external beam radiation therapy (EBRT). Twenty-four consecutive men with biochemical failure suspected of local recurrence after initial EBRT were enrolled prospectively in this study. All patients underwent a diagnostic 3T MR examination of the prostate. T2-weighted and dynamic contrast-enhanced MR images (DCE-MRI) were acquired. Two radiologists evaluated the MR images in consensus for tumor suspicious regions (TSRs) for local recurrence. Subsequently, these TSRs were biopsied under MR-guidance and histopathologically evaluated for the presence of recurrent PCa. Descriptive statistical analysis was applied. Tissue sampling was successful in all patients and all TSRs. The positive predictive value on a per patient basis was 75% (15/20) and on a per TSR basis 68% (26/38). The median number of biopsies taken per patient was 3, and the duration of an MRGB session was 31 minutes. No intervention-related complications occurred. The combination of MRGB and diagnostic MR imaging of the prostate was a feasible technique to localize PCa recurrence after EBRT using a low number of cores in a clinically acceptable time.

Current salvage methods for recurrent prostate cancer after failure of primary radiotherapy

We reviewed the current salvage methods for patients with local recurrent prostate cancer after primary radiotherapy (RT), using a search of relevant Medline/PubMed articles published from 1982 to 2008, with the following search terms: 'radiorecurrent prostate cancer, local salvage treatment, salvage radical prostatectomy (RP), salvage cryoablation, salvage brachytherapy, salvage high-intensity focused ultrasound (HIFU)', and permutations of the above. Only articles written in English were included. The objectives of this review were to analyse the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. There are four whole-gland re-treatment options (salvage RP, salvage cryoablation, salvage brachytherapy, salvage HIFU) for RT failure, although others might be in development or investigations. Salvage RP has the longest follow-up with acceptable oncological results, but it is a challenging technique with a high complication rate. Salvage cryoablation is a feasible option, especially using third-generation technology, whereby the average biochemical disease-free survival rate is 50-70% and there are fewer occurrences of severe complications such as recto-urethral fistula. Salvage brachytherapy, with short-term cancer control, is comparable to other salvage methods but depends on cumulative dosage limitation to target tissues. HIFU is a relatively recent option in the salvage setting. Both salvage brachytherapy and HIFU require more detailed studies with intermediate and long-term follow-up. As these are not prospective, randomized studies and the definitions of biochemical failure varied, there are limited comparisons among these different salvage methods, including efficacy. In the focal therapy salvage setting, the increased use of thermoablative methods for eligible patients might contribute to reducing complications and maintaining quality of life. The problem to effectively salvage patients with locally recurrent disease after RT is the lack of diagnostic examinations with sufficient sensitivity and specificity to detect local recurrence at an early curable stage. Therefore, a more strict definition of biochemical failure, improved imaging techniques, and accurate specimen mapping are needed as diagnostic tools. Furthermore, universal selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological efficacy and least comorbidity.

A Gender Transformation in Urology

A Gender Transformation in Urology

Treatment outcome and toxicity after salvage 125-I implantation for prostate cancer recurrences after primary 125-I implantation and external beam radiotherapy

Purpose To evaluate the outcome and toxicity after salvage iodine-125 (125-I) implantation in patients with locally recurrent prostate cancer after primary 125-I implantation and external beam radiotherapy. Methods and Materials Retrospectively, 31 patients were analyzed with pathology-proven local recurrent prostate cancer after primary external beam radiotherapy ( n = 20) or 125-I implantation ( n = 11), and who had undergone salvage 125-I implantation between 1994 and 2009. For recording biochemical failure rates, the Phoenix definition and the American Society for Therapeutic Radiology and Oncology definition were applied. Toxicity was scored according to the Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0) (Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Bethesda, MD). Results The mean (±standard deviation [SD]) followup was 9 years (±4). The freedom from biochemical failure after 1 and 5 years' followup were 51% and 20%, respectively. Fourteen (45%) patients died of prostate cancer after a mean (±SD) followup of 73 (±39) months. Grade 1, 2, or 3 toxicity of the genitourinary tract was reported in 29%, 58% and 3% of the patients, respectively, in the acute phase, and in 16%, 39%, and 19%, respectively, in the late phase. Grade 1, 2, or 3 toxicity of the gastrointestinal tract was reported in 45%, 10%, and 0% of the patients, respectively, in the acute phase, and in 48%, 3%, and 6%, respectively, in the late phase. Grade 4 toxicity of any tract occurred in none of the patients in the acute or the late phase. Conclusions Freedom from biochemical failure after salvage 125-I implantation for locally recurrent prostate cancer after radiotherapy is limited, and both genitourinary and gastrointestinal toxicity occur frequently.

Focal Salvage Guided by T 2-Weighted and Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Prostate Cancer Recurrences

Salvage treatment of the entire prostate for local recurrent cancer after primary radiotherapy is associated with high toxicity rates. Our goal was to show that, using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the visualization of a recurrence, focal salvage treatment can be performed, with, potentially, a reduction in toxicity. We performed MRI, including a DCE sequence, in 7 patients with biopsy-proven locally recurrent prostate cancer. The specific regions of interest suspect for containing tumor were delineated using DCE and T(2)-weighted MRI scans. Subsequently, focal salvage high-dose-rate brachytherapy plans were created to illustrate the principle of focal salvage. Total salvage treatment plans were also created for comparison. The transfer constant (K(trans)) values from the DCE were 0.33-0.67 min(-1) for areas suspect for tumor and 0.07-0.25 min(-1) for normal tissue. In 4 cases, a focal salvage plan could be generated; 93-100% of the gross tumor volume was covered with the prescribed dose, with relative sparing of the bladder, rectum, and urethra. In the total salvage plans, 24-53% of the gross tumor volume was covered, and the organs at risk received high doses. In 3 cases, a focal salvage plan could not be created because of multifocal tumor, seminal vesicle extension, or capsular extension. Focal salvage treatment plans can be created in patients with local recurrent prostate cancer after radiotherapy. DCE-MRI supports the localization of the target area. This could lead to less toxicity in patients with local recurrent prostate cancer.

18F-fluorocholine PET-guided target volume delineation techniques for partial prostate re-irradiation in local recurrent prostate cancer

Background and purpose We evaluate the contribution of 18F-choline PET/CT in the delineation of gross tumour volume (GTV) in local recurrent prostate cancer after initial irradiation using various PET image segmentation techniques. Materials and methods Seventeen patients with local-only recurrent prostate cancer (median = 5.7 years) after initial irradiation were included in the study. Rebiopsies were performed in 10 patients that confirmed the local recurrence. Following injection of 300 MBq of 18F-fluorocholine, dynamic PET frames (3 min each) were reconstructed from the list-mode acquisition. Five PET image segmentation techniques were used to delineate the 18F-choline-based GTVs. These included manual delineation of contours (GTV man) by two teams consisting of a radiation oncologist and a nuclear medicine physician each, a fixed threshold of 40% and 50% of the maximum signal intensity (GTV 40% and GTV 50%), signal-to-background ratio-based adaptive thresholding (GTV SBR), and a region growing (GTV RG) algorithm. Geographic mismatches between the GTVs were also assessed using overlap analysis. Results Inter-observer variability for manual delineation of GTVs was high but not statistically significant ( p = 0.459). In addition, the volumes and shapes of GTVs delineated using semi-automated techniques were significantly higher than those of GTVs defined manually. Conclusions Semi-automated segmentation techniques for 18F-choline PET-guided GTV delineation resulted in substantially higher GTVs compared to manual delineation and might replace the latter for determination of recurrent prostate cancer for partial prostate re-irradiation. The selection of the most appropriate segmentation algorithm still needs to be determined.

Salvage permanent perineal radioactive‐seed implantation for treating recurrence of localized prostate adenocarcinoma after external beam radiotherapy

To assess our experience with salvage permanent perineal radioactive-seed implantation (SPPI) as a possible therapeutic option for recurrent prostate adenocarcinoma, as salvage therapies for recurrences after definitive external beam radiotherapy (EBRT) for localized adenocarcinoma of the prostate are associated with significant morbidity and biochemical failure. We retrospectively analysed on patients who had SPPI for localized recurrent prostate adenocarcinoma from 1996 to 2007 after primary treatment with EBRT. Excluded were patients who had other primary treatment or had no follow-up. Primary outcomes were time to biochemical relapse-free survival, using the Phoenix definition of a prostate-specific antigen (PSA) nadir +2 ng/mL, and cancer-specific survival. Secondary outcomes were the International Prostate Symptom Score (IPSS), the International Index of Erectile Function-5 score (IIEF-5), and complications based on Common Terminology Criteria for Adverse Events (version 3). In all, 37 patients had SPPI during this period; after applying inclusion and exclusion criteria, 24 remained for analysis. At the time of salvage therapy, the median time to the diagnosis of local recurrence was 49 months, the median PSA level was 3.36 ng/mL, the median PSA doubling time was 20 months, and all patients were clinically re-staged at <or=T2 with negative transrectal ultrasonography and/or magnetic resonance spectroscopy. The original Gleason score was <or=6 in nine patients, 7 in eight and >or=8 in three (not recorded in two). The median follow-up after SPPI was 30 months; the cancer-free survival was 96% (one death) and biochemical relapse-free survival was 88% (three patients). The PSA level was higher than the levels before SPPI at 3 months in all three failures, but lower in all 21 patients considered relapse-free. Complications included one urethral stricture, one grade 3 rectal haemorrhage and five grade 2 gross haematuria that resolved with conservative management. Insufficient data were available to assess the IPSS or IIEF-5 scores. With a short-term follow-up SPPI appears to provide excellent prostate cancer control with an acceptable rate of complications for patients with local recurrence of prostate cancer after EBRT. An extended follow-up is necessary to determine the long-term durability and safety of SPPI.

PET/TAC con 11C-colina y 18F-FDG en pacientes con elevación de PSA tras tratamiento radical de un cáncer de próstata

ObjectiveTo compare the diagnostic accuracy of PET/CT with 18F-FDG and 11C-choline for early detection and localization of recurrent prostate cancer. Material and methodsThirty-eight patients with increased PSA levels (0.8-9.5 ng/ml) after radical treatment for prostate cancer (surgery n=20/radiation therapy n=18) were included. Ten patients were on hormone therapy. All patients underwent a PET/CT with 11C-choline and 18F-FDG, respectively, on the same day. The PET imaging findings were compared with histopathology (n=10); PSA monitoring (n=21) and/or other methods (n=7). ResultsFocal uptake of 11C-choline was detected in 26 patients (68%), and focal uptake of 18F-FDG was detected in 13 patients (34%). The 11C-choline uptake in 14 patients was suggested local recurrence, whereas this was true in only 4 patients (48%) with 18F-FDG.Pelvic lymph nodes were detected with 11C-choline PET/CT in 8 patients and only in 4 patients (50%) with 18F-FDG. Mediastinal involvement was detected in 5 patients with 11C-choline and 3 patients (60%) with 18F-FDG. Focal bone involvement was detected in 3 patients with 11C-choline and 18F-FDG. 11C-choline was able to detect 40% of recurrences in patients with PSA < 1ng/ml, 50% of recurrences in patients with PSA 1-4ng/ml and 87% of recurrences with PSA > 4ng/ml. Sensitivity of 11C-choline was higher for surgically treated patients, with no significant differences found between patients with and without hormone therapy. Conclusions11C-choline PET/CT was useful for the detection of biochemical recurrence of prostate cancer, with higher yielding as compared to 18F-FDG. 11C-choline sensitivity was clearly related to PSA levels, was higher in patients with surgery and did not seem to be modified by hormonal therapy. Disease staging with 11C-choline showed direct impact for the selection of the most appropriate therapeutic approach.

PET/CT with 11C-choline and 18F-FDG in patients with elevated PSA after radical treatment of a prostate cancer

ObjectiveTo compare the diagnostic accuracy of PET/CT with 18F-FDG and 11C-choline for early detection and localization of recurrent prostate cancer. Material and methodsThirty-eight patients with increased PSA levels (0.8-9.5 ng/ml) after radical treatment for prostate cancer (surgery n = 20/radiation therapy n = 18) were included. Ten patients were on hormone therapy. All patients underwent a PET/CT with 11C-choline and 18F-FDG, respectively, on the same day. The PET imaging findings were compared with histopathology (n = 10); PSA monitoring (n = 21) and/ or other methods (n = 7). ResultsFocal uptake of 11C-choline was detected in 26 patients (68%), and focal uptake of 18F-FDG was detected in 13 patients (34%). The 11C-choline uptake in 14 patients was suggested local recurrence, whereas this was true in only 4 patients (48%) with 18F-FDG.Pelvic lymph nodes were detected with 11C-choline PET/CT in 8 patients and only in 4 patients (50%) with 18FFDG. Mediastinal involvement was detected in 5 patients with 11C-choline and 3 patients (60%) with 18F-FDG. Focal bone involvement was detected in 3 patients with 11C-choline and 18F-FDG. 11C-choline was able to detect 40% of recurrences in patients with PSA < 1 ng/ml, 50% of recurrences in patients with PSA 1-4 ng/ml and 87% of recurrences with PSA > 4 ng/ml. Sensitivity of 11C-choline was higher for surgically treated patients, with no significant differences found between patients with and without hormone therapy. Conclusions11C-choline PET/CT was useful for the detection of biochemical recurrence of prostate cancer, with higher yielding as compared to 18F-FDG. 11C-choline sensitivity was clearly related to PSA levels, was higher in patients with surgery and did not seem to be modified by hormonal therapy. Disease staging with 11C-choline showed direct impact for the selection of the most appropriate therapeutic approach.

WHAT ARE THE BENEFITS AND THE RISKS OF A REPEATED SESSION OF HIGH INTENSITY FOCUSED ULTRASOUND FOR A RESIDUAL LOCALIZED PROSTATE CANCER?

Local occurrence of prostate cancer (PCa) after external beam radiation (EBRT) may benefit from definitive local therapy.To evaluate the safety and efficacy of salvage high-intenstiy focal ultrasound (HIFU) in local PCa recurrence after EBRT and to determine prognostic factors for optimal patient selection.Between 1995 and 2006, patients with a local PCa recurrence after EBRT were retrospectively included.All patients received salvage HIFU with the Ablatherm device.Prognostic factors (pre-EBRT risk group, androgen-deprivation [AD] use, pre-HIFU prostate-specific antigen [PSA], Gleason score and positive biopsy percentage) were studied in univariate and multivariate analyses. Progression was defined as positive biopsy and/or last PSA > nadir + 2 ng/ml and/or adjuvant therapy introduction. All complications were recorded.Some 194 HIFU sessions for 167 patients were performed. Local cancer control was achieved with negative biopsy results in 122 (73%) patients. The median PSA nadir was 0.19 ng/ml. The mean follow-up period was 18.1 mo (range: 3–121 mo). Seventy-four patients required no hormone therapy. The actuarial 5-yr overall survival rate was 84%. The actuarial 3-yr progression-free survival rate was significantly lower in three circumstances: (1) worsening of the pre-EBRT stage with 53%, 42%, and 25% for low-, intermediate-, and high-risk patients, respectively, (2) increase in the pre-HIFU PSA, and (3) use of AD during PCa management. In multivariate analyses, the risk ratio for intermediate- and high-risk patients were 1.32 and 1.96, respectively. The risk ratio was 2.8 if patients had received AD. No rectal complications were observed. Urinary incontinence accounted for 49.5% of the urinary sphincter implantations required in 11% of patients. This is a retrospective study in which the role of the PSA doubling time and the time until recurrence was not evaluated.Salvage HIFU is a curative treatment option for local relapse after EBRT with acceptable morbidity. Careful patient selection is imperative depending upon the aforementioned prognostic factors.

Critical analysis of salvage radical prostatectomy in the management of radioresistant prostate cancer

To critically evaluate salvage radical prostatectomy (SRP) in the treatment of patients with recurrent prostate cancer (PCa). From January 2005 to June 2007, we assessed patients with recurrent localized PCa. Recurrence was suspected when there were three or more successive increases in prostate specific antigen (PSA) after nadir. After the routine imagery examinations, and once localized PCa was confirmed, patients were offered SRP. Following surgery, we evaluated bleeding, rectal injury, urinary incontinence or obstruction and impotence. PSA values were measured at 1, 3, 6, months and thereafter twice a year. Forty-two patients underwent SRP. The average age was 61 years. Following radiotherapy, the mean PSA nadir was 1.5 ng/mL (0.57-5.5). The mean prostate specific antigen doubling time (PSA-DT) was 14 months (6-20). Prior to SRP, the mean PSA was 5.7 ng/mL (2.9-18). The pathologic staging was pT2a: 13%; pT2b: 34%; pT2c: 27%; pT3a: 13%; and pT3b: 13%. Bleeding > 600 mL occurred in 14% of the cases; urethral stenosis in 50%; and urinary incontinence (two or more pads/day) in 72%. The mean follow-up post-SRP ranged from 6 to 30 months. The PSA level rose in 9, of which 6 had PSA-DT < 10 months. SRP is a feasible method in the management of localized radioresistant PCa. PSA-DT has shown to be important for the selection and SRP should not be performed if PSA-DT > 10 months. Due to its increased morbidity, SRP should be only offered to the patients who are more concerned about survival rather than quality of life.

Hypermethylation of Genes for Diagnosis and Risk Stratification of Prostate Cancer

To identify the relevant CpG sites as molecular markers, for the diagnosis and to distinguish the indolent and aggressive prostate tumors, we have determined the methylation status of 8 genes, including FLNC, EFS, ECRG4, RARB2, PITX2, GSTP1, PDLIM4, and KCNMA1 in 32 nonrecurrent, 32 recurrent primary prostate tumors, and 32 benign prostate tissues using EpiTYPER technology. Specific CpG site hypermethylation of RARB2 and GSTP1 CpG sites were useful for diagnosis of prostate cancer. Furthermore, CpG site hypermethylation of genes FLNC, EFS, ECRG4, PITX2, PDLIM4, and KCNMA1 were associated with prediction of biochemical, local, and systemic recurrence of prostate cancer.

Therapeutic effects of gelatin matrix-embedded IL-12 gene-modified macrophages in a mouse model of residual prostate cancer

We evaluated the potential use of intraoperative gelatin matrix hemostatic sealant (GMHS; FloSeal; Baxter Healthcare) embedded with macrophages (Mphi) transduced with murine interleukin (IL)-12 recombinant adenoviral vector (G/Mphi/AdmIL-12) for prevention of recurrence of prostate cancer following radical prostatectomy. Application of G/Mphi/AdmIL-12 resulted in significant suppression of tumor growth and spontaneous lung metastases, a statistically significant survival advantage of the G/Mphi/AdmIL-12-treated animals, more efficient trafficking of Mphi to lymph nodes draining from the prostate and generation of systemic natural killer cell activity and tumor-specific cytolytic T lymphocyte responses compared to the controls in a preclinical mouse model of residual prostate cancer. Our data recommend this treatment as a novel adjuvant for prevention of local recurrence of prostate cancer following radical prostatectomy.

Mid-term results demonstrate salvage high-intensity focused ultrasound (HIFU) as an effective and acceptably morbid salvage treatment option for locally radiorecurrent prostate cancer: Murat FJ, Poissonnier L, Rabilloud M, Belot A, Bouvier R, Rouviere O, Chapelon JY, Gelet A, Urology Department, Val d'Ouest Hospital, Ecully, France; Urology and Transplantation Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

Background Local occurrence of prostate cancer (PCa) after external beam radiation (EBRT) may benefit from definitive local therapy. Objective To evaluate the safety and efficacy of salvage high-intensity focal ultrasound (HIFU) in local PCa recurrence after EBRT and to determine prognostic factors for optimal patient selection. Design, Setting, and Participants Between 1995 and 2006, patients with a local PCa recurrence after EBRT were retrospectively included. Intervention All patients received salvage HIFU with the Ablatherm device. Measurements Prognostic factors (pre-EBRT risk group, androgen-deprivation [AD] use, pre-HIFU prostate-specific antigen [PSA], Gleason score and positive biopsy percentage) were studied in univariate and multivariate analyses. Progression was defined as positive biopsy and/or last PSA > nadir+2 ng/ml and/or adjuvant therapy introduction. All complications were recorded. Results and Limitations Some 194 HIFU sessions for 167 patients were performed. Local cancer control was achieved with negative biopsy results in 122 (73%) patients. The median PSA nadir was 0.19 ng/ml. The mean follow-up period was 18.1 months (range: 3–121 mo). Seventy-four patients required no hormone therapy. The actuarial 5-year overall survival rate was 84%. The actuarial 3-yearr progression-free survival rate was significantly lower in 3 circumstances: (1) worsening of the pre-EBRT stage with 53%, 42%, and 25% for low-, intermediate-, and high-risk patients, respectively, (2) increase in the pre-HIFU PSA, and (3) use of AD during PCa management. In multivariate analyses, the risk ratio for intermediate- and high-risk patients were 1.32 and 1.96, respectively. The risk ratio was 2.8 if patients had received AD. No rectal complications were observed. Urinary incontinence accounted for 49.5% of the urinary sphincter implantations required in 11% of patients. This is a retrospective study in which the role of the PSA doubling time and the time until recurrence was not evaluated. Conclusions Salvage HIFU is a curative treatment option for local relapse after EBRT with acceptable morbidity. Careful patient selection is imperative depending upon the aforementioned prognostic factors.