HIFU as salvage therapy for radiation failure

One of the proposed uses for high-intensity focused ultrasound (HIFU)  has been as a treatment option for men with a rising PSA after first-line treatment with external beam radiation therapy (EBRT).

A new article by Berge et al. offers data on a small series of Norwegian patients treated with HIFU for progressive disease post-EBRT since October 2006. The abstract does not provide any detailed information about the type of HIFU equipment (Sonoblate or Ablatherm) used in this series of patients.

The key results from this case series are provided below:

  • The series included 46 patients, all of whom had negative bone scans and negative abdominal CT/MRI scans.
  • Median follow-up was 9 months (range, 3 to 24 months).
  • Median nadir PSA level was 0.3 ng/ml (range, 0 to 24 ng/ml).
  • 18/46 patients (39.1 percent) were formally classified as HIFU failures.
  • An additional 4/46 patients (8.7 percent) were not formally classified as HIFU failures but had  post-HIFU PSA nadir levels > 0.5 ng/ml.
  • No patient died during follow-up.
  • Significant complications and side effects included:
    • 1 patient with urethrorectal fistulae who was successfully treated.
    • 2 patients with urethrocutaneous fistulae.
    • 7/46 patients (15.2 percent) with grade 2 incontinence
    • 1/46 patients (2.1 percent) with grade 3 incontinence.
  • 7/46 patients (15.2 percent) had erectile function sufficient for intercourse pre-HIFU but only 2/46 (4.3 percent) did so post-HIFU.

The authors conclude that these early data on salvage HIFU in patients with local recurrence after EBRT suggest that the procedure may be “a reasonable treatment option.” However, they also note that, “The side-effects are not negligible,” and that “better patient selection criteria are needed.”

The “New” Prostate Cancer InfoLink would further note that the median follow-up on these patients is short, and it is hard to know, based on these data, how well these results would hold up over time. However, therapeutic options for men in early failure after first-line EBRT are limited. Salvage surgery is a difficult procedure that comes with a near guarantee of complete loss of erectile function and additional complications. The only other well-recognized options at this time are therefore hormone therapy or chemotherapy of some type (with or without hormones too). If it proved possible to define a set of patients in radiation failure who are demonstrably good candidates for salvage HIFU, then we would at least be able to have an extended set of options for these patients — albeit still less than ideal.

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