Pathologic, Oncologic and Functional Outcomes of a Prospective Registry of Salvage High Intensity Focused Ultrasound Ablation for Radio-Recurrent Prostate

and Objective: The objective of this Prospective Registry was to prospectively assess the oncologic, functional and safety outcomes of salvage HIFU in radio-recurrent prostate cancer (rrPCa).

Eighty one men were prospectively recruited and evaluated at regular scheduled study visits to 6 months post-HIFU and thereafter as per standard of care. Transrectal ultrasound guided biopsy (TRUS Bx) was performed at 6 months. Primary endpoint was absence or histologic persistence of disease at 6 months Bx. Secondary endpoints included QoL, biochemical recurrence-free survival (BRFS), overall survival (OS), cancer specific survival (CSS) and progression to androgen deprivation therapy (ADT). Survival analysis was carried out according to Kaplan-Meier's method and multivariate analysis was performed using the log-rank (Mantel-Cox) test.

The mean pre-HIFU PSA was 4.06 ± 2.88 ng/mL. At 6 months, 63 men underwent Bx, of which 22 (35%) were found to have residual disease. With a mean follow-up of 53.5 ±31.6 months, the median BRFS was 63 months. The 5-year OS and CSS were 88% and 94.4% respectively. Nadir PSA of <0.5ng/mL was a significant predictor (p=0.014, 95% CI 1.22-5.87) of BRFS. IPSS scores significantly increased (p<0.001) while IIEF-5 scores decreased and the SF-36 score did not change significantly. The rate of rectal fistulization and severe incontinence was 3.7% each. A total of 223 complications were recorded in the 180-days after HIFU (Clavien-Dindo grades 1=195, grade II= 20, grade III= 7, grade IVa=1).

Salvage HIFU appears to be a viable treatment option for rr-PCa, with acceptable morbidity.

The Journal of urology. 2016 Jul 12 [Epub ahead of print]

Khurram M Siddiqui, Michele Billia, Andrew Arifin, Fan Li, Philippe Violette, Joseph L Chin

Western University, London, Ontario, Canada., Western University, London, Ontario, Canada., Western University, London, Ontario, Canada., Western University, London, Ontario, Canada., Woodstock Hospital, Woodstock, Canada., Western University, London, Ontario, Canada.

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