Prostate Cancer - Local Treatment after Radiorecurrence: HIFU - High-Intensity Focused Ultrasound (original) (raw)

International braz j urol : official journal of the Brazilian Society of Urology

Currently, about one third of all newly diagnosed prostate cancer patients select radiotherapy or brachytherapy (BT) as their primary treatment (1). Primary external beam radiation therapy (EBRT) in localized prostate cancer has a risk of biochemical recurrence about 30-60% (1, 2). The most widely utilized criteria for EBRT biochemical relapse is the Phoenix definition (2006). It is established as a PSA elevation of ≥ 2 ng/mL above the nadir PSA (3).There are a variety of treatment options, like watchful waiting, androgen deprivation therapy (ADT) and local salvage therapies. None of them are accepted as gold standard salvage treatments. Another important point is that recurrences are associated with an increased risk of death, metastases and local complications, such as ureteral obstruction, hematuria and pelvic pain (1). Recent scenario shows that about 70% of these patients receive ADT, but with a decreasing trend over the time (4). ADT is not a curative treatment and it is associated with significant side effects, such as cardiovascular events, sexual dysfunction, humor disabilities, loss of bone mineral density and muscular atrophy. Indeed, proper salvage treatments are mandatory, especially in patients with good health status. We think that, among this population of men underwent upfront ADT, it is possible to select patients which can be submitted to local salvage procedures. Salvage treatments for local recurrences are adequate after excluded systemic disease with a confirmatory biopsy sample of prostatic tissue and imaging modalities, such as magnetic resonance imaging, computed tomography, bone scan or even combined nuclear medicine techniques (choline PET/CT and PSMA PET/CT). Salvage local treatments are characterized by significant morbidity, with increased risk of rectal injuries and post-treatment incontinence or urethral stenosis that may be as high as 50% (5). Salvage radical prostatectomy (SRP) is an accepted challenging alternative, due to the fact it is associated with a high morbidity rate, however less than 1% of patients in that situation receive this kind of approach (4). Reports have shown a 5-year and 10-year biochemical recurrence free rates of 47-82% and 28-53%, respectively, and a 5-year and 10-year cancer specific survival of 70-83% and 54-89%, respectively (6). A recent review by Golbari et DiffErENCE Of OpiNiON