HIFU in Radio-Recurrent Localized Prostate Cancer - Beyond the Abstract

External Beam Radiation Therapy (EBRT) is a valid option for the treatment of clinically localized prostate cancer. Localized radio-recurrent disease can be proven after biopsy in the range of 3-10% after ERBT, and different treatments are available. Among these, High Intensity Focused Ultrasound (HIFU) is getting a growing interest, although it is still recommended within clinical trial settings or well-designed prospective cohort studies. Therefore, its role in the salvage setting needs to be well illustrated.

In the present literature review, we considered data on 1241 patients coming from 13 study, 179 (18.8%) low-risk patients, 337 (35.5%) intermediate-risk patients, 443 (45.6%) high-risk patients. Unfortunately, the radiotherapy scheme was not reported in all studies for each patients’ group. However, oncological outcomes (overall survival 85.2% at 5 years, and 72% after 7 years in one study) were acceptable with a mean follow-up of 24.3. Interestingly, patients with pre-operative low-risk disease and low- preoperative PSA levels seem to have a better prognosis.

Specific report on short- and long-term toxicity of HIFU-profile was not standardly reported. This represents an important bias in order to evaluate the incidence of technique-related complications and the impact on functional outcomes as for example urinary fistula incidence, and continence and potency. Further well-designed prospective trials are needed in order to define the exact role of HIFU in patients with radio-recurrent localized prostate cancer.

Written by:

  • Dr. Alessandro Tafuri, Department of Urology, “Vito Fazzi” Hospital, Lecce, Italy
  • Dr. Umberto Maestroni, Department of Urology, University-Hospital of Parma, Italy
  • Prof. Alessandro Antonelli, Department of Urology, University of Verona, Italy.

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