Salvage treatment options for prostate cancer after the failure of radiation as a primary treatment is often seen as a reason to avoid radiation as a primary treatment modality. The common collective wisdom is that after failed radiation our options for additional treatment of recurrent prostate cancer are limited to systematic treatments, hormone therapy, Ketoconazole and Taxotere.
Recently, there has been a small study to determine the efficacy and adverse effects of high intensity focused ultrasound (HIFU) for the treatment of la ocal recurrence of prostate cancer after the use of external beam radiotherapy.
In the study, seventy-two patients with a local recurrence of prostate cancer after radiotherapy were treated by HIFU. The mean age of the men was 68.27 years, and their mean PSA was 6.64 ng/ml. ASTRO 2005 criteria, specific for salvage therapy (Phoenix consensus), was used to define recurrence and the progression-free survival was calculated by the Kaplan-Meier method.
Mean follow-up time with the men was 39 months. The negative biopsy rate was 80% and the median nadir PSA was 0.10ng/ml. Specific survival was 94% at three years and 90% at five years. The progression-free survival was 50% at three years and 44% at five years.
The urinary incontinence rate was 44% (grade 1 : 12%, grade 2/3 : 32%) and the urethral stricture or bladder neck stenosis rate was 30%.
Adjuvant treatment using HIFU after failed radiation managed to achieved a five-year progression-free survival of 44%. However, the high negative impact on their quality of life must be noted. Before using HIFU as a second line treatment, men must be clearly informed of the high potential for incontinence and urethral strictures.
Additionally, since the progression free survival rate is only at 50% at three years, many men will still have to rely on systematic treatments (and suffer with their quality of life issues) to extend their lives.
Prog Urol. 2008 Apr;18(4):223-229.
Joel T Nowak MA, MSW