Korean J Urol.  2014 Feb;55(2):91-96. 10.4111/kju.2014.55.2.91.

High-Intensity Focused Ultrasound as Salvage Therapy for Patients With Recurrent Prostate Cancer After Radiotherapy

• Song W
• Jung US
• Suh YS
• Jang HJ
• Sung HH
• Jeon HG
• Jeong BC
• Seo SI
• Jeon SS
• Choi HY
• Lee HM

• KMID: 1988432
• DOI: http://doi.org/10.4111/kju.2014.55.2.91

Abstract

PURPOSE
To evaluate the oncologic outcomes and postoperative complications of high-intensity focused ultrasound (HIFU) as a salvage therapy after external-beam radiotherapy (EBRT) failure in patients with prostate cancer.
MATERIALS AND METHODS
Between February 2002 and August 2010, we retrospectively reviewed the medical records of all patients who underwent salvage HIFU for transrectal ultrasound-guided, biopsy-proven locally recurred prostate cancer after EBRT failure (by ASTRO definition: prostate-specific antigen [PSA] failure after three consecutive PSA increases after a nadir, with the date of failure as the point halfway between the nadir date and the first increase or any increase great enough to provoke initiation of therapy). All patients underwent prostate magnetic resonance imaging and bone scintigraphy and had no evidence of distant metastasis. Biochemical recurrence (BCR) was defined according to the Stuttgart definition (PSA nadir plus 1.2 ng/mL).
RESULTS
A total of 13 patients with a median age of 68 years (range, 60-76 years) were included. The median pre-EBRT PSA was 21.12 ng/mL, the pre-HIFU PSA was 4.63 ng/mL, and the period of salvage HIFU after EBRT was 32.7 months. The median follow-up after salvage HIFU was 44.5 months. The overall BCR-free rate was 53.8%. In the univariate analysis, predictive factors for BCR after salvage HIFU were higher pre-EBRT PSA (p=0.037), pre-HIFU PSA (p=0.015), and short time to nadir (p=0.036). In the multivariate analysis, there were no significant predictive factors for BCR. The complication rate requiring intervention was 38.5%.
CONCLUSIONS
Salvage HIFU for prostate cancer provides effective oncologic outcomes for local recurrence after EBRT failure. However, salvage HIFU had a relatively high rate of complications.

Keyword

High-intensity focused ultrasound ablation; Prostatic neoplasms; Salvage therapy

MeSH Terms

Follow-Up Studies
High-Intensity Focused Ultrasound Ablation
Humans
Magnetic Resonance Imaging
Medical Records
Multivariate Analysis
Neoplasm Metastasis
Postoperative Complications
Prostate*
Prostate-Specific Antigen
Prostatic Neoplasms*
Radionuclide Imaging
Radiotherapy*
Recurrence
Retrospective Studies
Salvage Therapy*
Ultrasonography*
Prostate-Specific Antigen

Figure

• 

  FIG. 1 Kaplan-Meier curve demonstrating the biochemical recurrence (BCR)-free survival rate after salvage high-intensity focused ultrasound (HIFU) therapy. The 5-year biochemical recurrence-free survival rate is 53.8% (95% confidence interval, 26.8-80.8).

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