Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography.

OBJECTIVES: To evaluate the efficacy and safety of a salvage therapy using transrectal high-intensity focused ultrasonography (HIFU) for locally recurrent prostate cancer after external beam radiotherapy.

METHODS: All patients were treated with HIFU under general or spinal anesthesia. Specific parameters were progressively defined to avoid any rectal damage. Patient follow-up included sextant biopsy and prostate-specific antigen (PSA) measurement.

RESULTS: A total of 71 patients were included in this series. The main baseline characteristics before HIFU were mean age 67 +/- 5.86 years, mean prostate volume 21.4 +/- 11.1 cm(3), and mean PSA level 7.73 +/- 8.10 ng/mL. All biopsies were positive, with a pre-HIFU Gleason score of 2 to 6 in 24 patients, 7 in 13 patients, and 8 to 10 in 34 patients. The mean patient follow-up was 14.8 months (range 6 to 86). After HIFU treatment, 57 (80%) of the 71 patients had negative biopsies, and 43 (61%) of 71 had a nadir PSA level of less than 0.5 ng/mL. The nadir level was obtained within 3 months. At the last follow-up, 44% of the patients had no evidence of any disease progression. The adverse events related to HIFU included rectourethral fistula in 6%, grade 3 incontinence in 7%, and bladder neck stenosis in 17%. No rectal injury occurred with the use of specific parameters.

CONCLUSIONS: HIFU appears to be a promising treatment option with a curative chance for patients with local recurrence after external beam radiotherapy. The HIFU-related morbidity was lower than the morbidity reported after other types of salvage therapy, leading to a favorable risk/benefit ratio.