Using focal thermo-ablative therapy for treating oligo-recurrent prostate cancer after radiotherapy.

This study assessed patient responses to focal thermo-ablative therapy (FTA) for oligo-recurrent prostate cancer (PCa) after pelvic radiotherapy. The data suggested that FTA therapy is a good option in these patients.

Oligometastatic PCa means that cancer has spread to only a few places (up to 5 metastases). It is considered a transitional state between localized disease (confined to the prostate gland) and widespread metastatic disease (distal spread to other body parts).

Radiotherapy (RT) to the pelvic area (lower abdomen) is a common treatment option in patients with PCa. If the cancer returns to the pelvic region (in-field oligometastatic PCa), other localized therapies such as RT, surgery, or FTA therapy can be given. The goal of localized therapies is to delay systemic (whole-body) treatments such as hormonal therapy or chemotherapy that may have serious side effects on the quality of life of patients. 

FTA involves the use of extreme temperatures (heat or cold) to destroy tumors. FTA includes radiofrequency (uses electrical energy and heat) or cryoablation (freezes and kills PCa cells) techniques. Whether FTA is a good treatment option in oligometastatic PCa after RT to the pelvic area is still unknown. 

This study involved 43 men with in-field oligometastatic PCa relapses after pelvic RT. All patients were treated with FTA therapy. The average follow-up was 30 months. A prostate-specific antigen (PSA) response (a reduction of PSA levels) was evaluated. PSA is a protein made by the prostate that is high in PCa and decreases with successful treatment. 

Overall, 41.9% of patients had a PSA response. 30.3% had a complete response (PSA levels below 0.05 ng/ml) and 11.6% had a partial response (more than 50% decrease in PSA levels). The average time without cancer worsening was 9 months overall. In patients with a PSA response, the average time without cancer worsening was 17 months. The average time until hormonal therapy was started was 11 months.

11.6% of patients experienced side effects. Most of these were mild and included pain in the area of the procedure and pain while urinating. 

The study showed that FTA procedures for in-field oligo-recurrent PCa are a good option in patients with PCa after RT.  

The study was based on patient results from a single site and the sample size was limited. Further, larger studies are needed.