Combinations of HIFU + radiation as salvage therapy for recurrent prostate cancer

A newly published paper from a clinical research group in Nice, France, has reported very limited data on a small cohort of patients with recurrent localized prostate cancer after first-line therapy who were given salvage therapy using various combinations of radiation therapy and high-intensity focused ultrasound (HIFU).

The paper by Lee et al. provides data on just 19 patients, all of whom had failed first-line therapy (which we assume to have been surgery, but the paper’s abstract is not explicit about that). It should also be made clear that there seems to be enormous variation in the clinical characteristics of these patients and when they were treated. For example:

  • The patients’ ages ranged from 53 to 72 years (median, 66.5 years).
  • Their PSA levels at time of salvage therapy ranged from 3.4 to 50.0 ng/ml (median, 10.8 ng/ml).
  • Their Gleason scores ranged from 5 to 8.
  • Follow-up ranged from 2 to 106 months (median, 46.3 months).

The patients were also treated with a variety of differing combinations of radiation therapy and HIFU, as follows:

  • 10 patients seem to have been treated with HIFU followed by external beam radiation therapy (EBRT).
  • 4 patients were treated with EBRT followed by HIFU.
  • 5 patients were treated by brachytherapy followed by HIFU.

About the only useful information that we can take away from this paper is that

  • It is clearly possible to give combinations of HIFU and radiation as forms of salvage therapy.
  • The combination of brachytherapy followed by HIFU seems to have been associated with a relatively high risk for urinary tract complications and side effects.

The best way to look at this paper is that it can be considered a “feasibility” study showing that combination of HIFU with radiation therapy is possible.

The authors offer no information about the effectiveness of these different types of salvage therapy (i.e., the patients’ outcomes over time). Without specific data on effectiveness, the clinical value of any of these forms of salvage therapy is impossible to determine. In addition, since the variation between the patients seems to be considerable, it is also hard to get any clear idea of whether there might be any greater benefit to combination salvage of this type in any particular subset of patients.

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