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Posted by on Jun 30, 2019 in Prostate cancer | 0 comments

In a nutshell

This article investigated the safety and effectiveness of salvage high-intensity focused ultrasound (S-HIFU) in patients with locally recurrent prostate cancer (LRPC; cancer which has come back and is confined to the prostate gland) after treatment with low dose rate brachytherapy (BT). 

The authors concluded that S-HIFU is an effective treatment option to increase survival with a risk of more side effects.

Some background

Localized PC is cancer that is confined to the prostate gland. One current treatment includes low dose BT. This is a type of radiation therapy (RT; uses high doses of radiation to kill cancer cells and shrink tumors). The radiation source is implanted into the tumor. RT has been associated with a risk of cancer recurrence.

An alternative option for patients that have relapsed is with S-HIFU. S-HIFU uses heat to remove the cancerous tissue in the prostate gland. It is not known if S-HIFU is safe and effective in patients previously treated with RT.

Methods & findings

The study involved 50 male patients with localized PC. All patients were initially treated with BT. After recurrence, they were treated with S-HIFU. One group (group 1) included 35 patients and received whole-gland ablation (WGA; both sides of the prostate gland tissue were removed). Group 2 (15) received hemi-ablation (HA; only one side of the prostate gland tissue was removed). Follow up was on average 4.6 years. Survival rates and side effects were measured.

After 6 years, the treatment failure-free survival (number of patients with the absence of cancer returning or need for more treatment) was 41%. The progression-free survival (patients alive with the disease but it does not get worse) was 45%. The overall survival after 5 years was 93%. This rate was 87% after 7 years.

The cancer-specific survival (percentage of patients who have not died from cancer) was 98% of patients after 5 years. Survival without cancer spreading to other organs was 80% after 5 years. 

The side effects after BT were urinary incontinence (UI; involuntary leakage of urine), and bladder outlet obstruction (BOO; blockage of the passage of urine). UI was less likely to occur after HA in group 2 (14%) compared with WGA in group 1 (54%). BOO was also less likely to occur after HA in group 2 (13%) compared with WGA in group 1 (46%). After treatment with S-HIFU, erectile function was maintained in 48% of the patients after 12 months. 

The bottom line

The authors concluded that S-HIFU is an effective treatment option to increase survival. The authors suggested that HA might increase the safety of the treatment compared to WGA.  

The fine print

This study had a small sample size. Further studies with longer follow up times are needed to confirm the results of the study. 

Published By :

BJU international

Date :

May 30, 2019

Original Title :

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

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