Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients

To report the oncological outcome of Salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer (PCa) following External Beam Radiotherapy (EBRT) from a multicenter database.

This retrospective study comprises patients from 9 centers with local recurrent disease following EBRT treated with S-HIFU from 1995 to 2009. Biochemical free survival rates (BFSR) was based on the "Phoenix" definition (nadir+2). Secondary end points included progression to metastasis and cancer-specific death. Kaplan-Meier analysis was performed examining overall, tumor specific and metastasis free survival. Adverse events and quality of life status are reported.

A total of 418 patients with a mean follow-up of 3.5±2.5 years were included. The average age was 68.6±5.8 years. The average PSA pre S-HIFU was 6.8±7.8ng/ml. The median PSA nadir after S-HIFU was 0.19ng/ml. The overall, cancer specific and metastasis free survival rate at 7 years were 72%, 82% and 81%, respectively. At 5 years the BFSR was 58%, 51% and 36% for pre EBRT low-, intermediate- and high-risk patients, respectively. The 5 years BFSR was 67%, 42% and 22% for pre S-HIFU PSA ≤4, 4 to 10 and ≥10ng/ml respectively. Complication rates decreased after the introduction of specific post-radiation treatment parameters: incontinence (grade II or III) from 32% to 19% (p=0.002); bladder outlet obstruction (BOO) or stenosis from 30% to 15% (p=0.003); urethro-rectal fistula decreased from 9% to 0.6% (p<0.001).

retrospective analysis from registry with no control group.

S-HIFU for locally recurrent PCa after failed EBRT is associated with 7-year specific and metastasis free survival rates over 80% at a price of significant morbidity. S-HIFU should be initiated early following EBRT failure. This article is protected by copyright. All rights reserved.

BJU international. 2017 Jan 07 [Epub ahead of print]

Sebastien Crouzet, Andreas Blana, Francois J Murat, Gilles Pasticier, Stephen C W Brown, Giario N Conti, Roman Ganzer, Olivier Chapet, Albert Gelet, Christian G Chaussy, Cary N Robertson, Stefan Thuroff, John F Ward

Department of Urology, Edouard Herriot Hospital, Lyon, France., Department of Urology, Fuerth Hospital, Fürth, Germany., Urology Department, Val d'Ouest Hospital, Ecully, France., Department of Urology, CHU Pellegrin, Bordeaux, France., Department of Urology, Stepping Hill Hospital, Stockport, UK., Department of Urology, St. Anna Hospital, Como, Italy., Department of Urology, University of Regensburg, Germany., Department of radiation Oncology, Lyon Sud Hospital, Pierre Bénite, France., Department of Urology, Duke University, Durham, US., Department of Urology, Harlaching Hospital, Munich, Germany., Department of Urology, M. D. Anderson Cancer Center, Houston, US.