Salvage high-intensity focused ultrasound for locally recurrent prostate cancer after brachytherapy

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.

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.

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 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.  

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