Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy

Objective To report our experience with salvage high-intensity focused ultrasound (HIFU) in patients with local failure after brachytherapy for prostate cancer.

Patients and Methods Whole-gland HIFU was administered to prospectively recruited patients with local histologic failure after brachytherapy at 2 institutions in the United Kingdom and Canada. Functional and oncologic outcomes of the procedure were analyzed.

Results Nineteen patients underwent the treatment, 12 with Gleason sum 7 and 5 with Gleason sum 8 at recurrence. Thirteen men had grade-3a or -3b complications by the Clavien system; there were no grade-4 or -5 complications. The most common postoperative complication was dysuria, which was self-limited. Three men developed rectourethral fistulae. The overall continence rate was 68.4%. At a mean follow-up of 51.6 months, all men were alive. The overall biochemical recurrence-free survival rate was 66.7% and 73.3% using the "nadir prostate-specific antigen level" +1.3 ng/mL and +2 mg/ml criteria, respectively. This study is limited by the small cohort size, relatively short follow-up period, and heterogeneity of the patient population.

Conclusion In this, the largest prospective series to date, we demonstrate that salvage HIFU for locally recurrent prostate cancer after failed primary brachytherapy has encouraging disease control results, albeit with a relatively high complication rate.