The Tuesday news reports: March 31, 2009

In today’s news there are reports on:

  • Initial diagnosis of intraductal carcinoma of the prostate
  • An aborted trial of HIFU using the Ablatherm device
  • Late rectal complications after prostate brachytherapy

Henry and Evans have reviewed available data on intraductal carcinoma of the prostate (IDCP), which has been described as a prostate cancer lesion associated with poor prognostic features. Recognition and reporting of this lesion is critical as it carries significant implications for patient management. The authors offer an historical overview of the description of IDCP, a summary of the current histological diagnostic criteria, and the recommendations for management and reporting of IDCP.

Challacombe et al. have reported data on the short-term functional and oncological results of high-intensity focused ultrasound (HIFU) for treating localized prostate cancer at a single institution, using a second-generation Ablatherm™ device. Over a 3-year period, 43 patients with localized prostate cancer were scheduled for HIFU in the primary (31) and salvage (12) settings. Three patients had their procedures abandoned due to technical limitations/rectal wall thickness. Using the Phoenix definition of biochemical failure, HIFU treatment failed in 13/31 patients in the primary group (46 percent) and 5/12 in the salvage group. Using the FDA trial endpoint, HIFU failed in 21/31 patients in the primary group (75 percent) and 8/12 in the salvage group. One man died from metastatic prostate cancer 18 months after salvage HIFU. There were two urethral strictures in the primary (7 percent) and one in the salvage treatment group. There were two prostato-rectal fistulae in the salvage HIFU group. The asuthors report that, since their data do not support the theory that HIFU is and effective, minimally invasive, low-morbidity, ablative treatment for localized prostate cancer, they have suspended their program pending further evidence of its safety and efficacy.

Phan et al. have reviewed the literature on late rectal complications after prostate brachytherapy They state that  brachytherapy is a highly effective treatment modality for patients with clinically localized prostate cancer but that it can cause chronic radiation proctitis, most common manifested as anterior rectal wall bleeding,often occurring within the first 2 years after brachytherapy. However, the rates of late rectal morbidity appear to have declined over time, which may reflect improvements in implantation techniques and imaging. They also state that rectal biopsy as part of the work-up to evaluate rectal bleeding can lead to rectal fistula and the need for colostomy, a rare but major complication. The authors recommend: (1) screening colonoscopy before brachytherapy for patients who have not had a screening colonoscopy within the preceding 3 years to rule out colorectal malignancies and, thus, facilitate conservative management should rectal bleeding occur; (2) lifestyle modifications during treatment to limit exposure of the rectum to radiation; and (3) conservative management for rectal bleeding that occurs within 2 years after brachytherapy.

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