Salvage high-intensity focused ultrasound for locally recurrent prostate cancer after low-dose-rate brachytherapy: oncologic and functional outcomes.

To evaluate the oncologic and functional outcomes of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after low-dose rate brachytherapy.

Clinical phase II studies (2003-2015) included 50 consecutive patients with post-brachytherapy local recurrence treated by S-HIFU. S-HIFU was performed with post-external beam radiotherapy parameters and, since 2008, with specific post-brachytherapy parameters. Treatments were whole-gland ablation and, since 2009, hemiablation in cases of unilateral prostate cancer. The primary objective was to assess oncological outcomes: treatment failure-free survival, progression free survival, overall survival, cancer-specific survival and metastasis-free survival rates. The secondary objective was to evaluate adverse events, continence, and erectile function. Kaplan-Meier analysis estimated oncologic outcomes.

Thirteen patients were treated with post-external beam radiotherapy parameters, 37 with post-brachytherapy parameters, 35 with whole-gland treatment, and15 with hemiablation. The median follow-up was 4.6 years. After S-HIFU, the median prostate specific antigen was 0.3 ng/ml. At 6 years, treatment failure free survival, progression-free survival, overall survival, cancer-specific survival, and metastasis-free survival rates were 41%, 45%, 93%, 98% and 80%, respectively. Post-brachytherapy compared with post-external beam radiotherapy parameters reduced grade 2-3 incontinence (34% vs 62%, p=0.015). Incontinence, bladder outlet obstruction and grade ≥ III complications were significantly reduced with hemiablation compared with whole-gland treatment (14% vs 54%, p < 0.001; 13% vs 46%, p=0.03; 13% vs 63% p=0.001, respectively). Before S-HIFU, 25 patients had an International Index of Erectile Function-5 ≥ 17, which was maintained in 48% at 12 months.

Salvage HIFU for locally recurrent prostate cancer after low-dose rate brachytherapy is associated with favourable survival rates at a price of significant morbidity. Dedicated post-brachytherapy parameters and hemiablation improve the safety of the treatment. This article is protected by copyright. All rights reserved.

BJU international. 2019 May 30 [Epub ahead of print]

Thomas Hostiou, Albert Gelet, Jean-Yves Chapelon, Olivier Rouvière, Florence Mège-Lechevalier, Cyril Lafon, Hélène Tonoli-Catez, Lionel Badet, Sébastien Crouzet

Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.