Focal salvage therapy for treatment of radiorecurrent prostate cancer

A new paper in the World Journal of Urology has reviewed the available evidence that focal forms of salvage therapy may be usable in men with biochemically recurrent prostate cancer after first-line radiation therapy (“radiorecurrent” prostate cancer).

The new paper by Smit Duijzentkunst et al. from the University of Utrecht was intended to explore the available, published data to see whether focal salvage might have a comparable or favorable recurrence rate and less toxicity when compared to whole-gland salvage therapies (other than salvage surgery) for radiorecurrent disease.

The authors surveyed a total of 3,015 articles and found just eight papers that could be used to report outcomes data: three papers dealt with salvage

“> focal cryoablation, three with salvage brachytherapy, and two with salvage high-intensity focused ultrasound (HIFU).

Based on data from these eight papers, they report that:

  • Rates of biochemical disease-free survival after focal salvage therapy for radiorecurrent disease were
    • 69 to 100 percent at 1 year
    • 49 to 100 percent at 2 years
    • 50 to 91 percent at 3 years
    • 46.5 to 54.5 percent at 5 years
  • Severe side effects (toxicity) were evident in 0 to 33 percent of patients.
  • Such side effects were evident in the gastrointestinal tract, in the genitourinary tract, and on sexual function.

The authors note that one of the eight studies was a direct comparison of the outcomes of patients treated by focal as opposed to whole-gland salvage cryotherapy. That study showed that

  • 5-year biochemical disease-free survival was
    • 54.4 percent after focal salvage cryotherapy
    • 86.5 percent after whole-gland salvage cryotherapy
  • Toxicity rates were significantly lower among the focal salvage patients.

The authors conclude that, in their opinion, there are early and provisional data to suggest that biochemical disease free survival  rates after focal salvage therapy for radiorecurrent prostate cancer

are in line with those of whole-gland approaches. There is evidence that focal salvage could decrease severe toxicity and preserve erectile function.

The “New” Prostate Cancer InfoLink would note only that the applicability of focal salvage therapy of any type to such patients, not to mention the quality of the expected outcome, is highly dependent on the criteria used to select appropriate patients for such treatments. It is easy to “over-treat” older men with a very slowly progressing prostate cancer after first-line therapy (when such men may be at extremely low risk for metastatic disease or prostate cancer-specific death). It is also easy to use focal therapy inappropriately by trying it on men who are at high-risk for multi-focal disease or locally advanced forms of prostate cancer.

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