Salvage High-Intensity Focused Ultrasound for Prostate Cancer after Radiation Failure: A Narrative Review
Abstract
1. Introduction
2. Methods
3. Results and Discussion
3.1. Criteria for Selecting Patients
3.2. Oncological and Survival Outcomes
3.3. Urinary Functional Outcomes
3.4. Sexual Function Outcomes
3.5. Perioperative and Long-Term Complications
3.6. Specific Indications for Select Patients Based on Location of Reccurence or Post-Radiation Clinical Parameters
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author and Year of Publication | Study Type | Country | Focal/Whole Gland | Sample Size | Median Age | Primary Radiation Treatment Type | Mean Radiation Dose (SD), Cycle, or Seed Type | Androgen Deprivation Therapy | Time from Primary Treatment to Salvage |
---|---|---|---|---|---|---|---|---|---|
Nair et al., 2021 [35] | Retrospective | Canada | Whole | 113 | 63.3 | BT and EBRT | NA | 20.4% | 14.3 years |
Hostiou et al., 2019 [23] | Retrospective | France | Whole (hemi-ablation when unilateral in some cases) | 50 | 62.1 | BT | Iodine-125 (96%) Iridium-192 (2%) Unknown (2%) | 16% | NR |
Devos et al., 2019 [24] | Retrospective | Belgium | Whole | 27 | 69.9 | EBRT | EBRT: 70.7 ± 2.7 BT: 70.1 ± 3.3 | 31%N-AD | NR |
Jones et al., 2018 [25] | Prospective | USA | Whole | 100 | 70 | EBRT | NA | None within 3 months of HIFU | 24 mo minimum |
Dason et al., 2018 [26] | Prospective | Canada | Whole | 24 | 68 | 88%: EBRT 12%: BT | NA | 25% | NR |
Siddiqui et al., 2017 [27] | Prospective | UK | Whole | 81 | 69 | 82.7%: EBRT 16.1%: BT | NA | 26.9% | NR |
Kanthabalan et al., 2017 [28] | Retrospective | UK | Focal | 150 | 69.8 | 96.7%: EBRT 3.3%: EBRT + BT | 64 in 32 fractions | 45.3%: pre-salvage | 80 mo |
Crouzet et al. 2017 [20] | Retrospective | France | Whole | 418 | 68.6 | EBRT | NA | None within 3 months of HIFU | 5.1 ± 2.7 yrs |
Shah et al., 2016 [29] | Prospective | UK | Whole | 50 | 68 | EBRT | Range: 50–72 in 20–35 fractions, Median 57.5 | 52% (after biochemical failure) | 80 mo |
Siddiqui et al., 2015 [30] | Retrospective | UK | Whole | 65 | 71 | 93.8%: EBRT 6.2%: BT | NA | 21% | NR |
Yutkin et al., 2014 [33] | Prospective | Canada | Whole | 19 | 60 | BT | Iodine-125 (94.7%) high-dose rate Iridium (5.3%) | 27% N-AD | 72 |
Baco et al., 2014 [31] | Prospective | France and Norway | Focal | 48 | 68.8 | 95.8%: EBRT 4.2%: BT | 72.5 ± 3.3 | 22.9%: N-AD | NR |
Song et al., 2014 [32] | Retrospective | Korea | Whole | 13 | 68 | EBRT | NA | 8/13 pre-salvage for 2 months | 32.7 months median |
Rouvière et al., 2013 [34] | Retrospective | France | Whole | 46 | NR | EBRT | NA | N-AD32% | NR |
Author and Year of Publication | Oncologic Outcomes | Key Findings |
---|---|---|
Nair et al., 2021 [35] | Median OS S-HIFU 17.4 yr vs. 12.8 yr for NST (no salvage treatment) although not statistically significant | 52 deaths (31 from PCa) for NST (no salvage therapy) group vs. 18 deaths (9 from PCa) for S-HIFU; however, no significant difference in CSS or OS likely due to reduced sample size and shorter follow-up of S-HIFU group. |
Hostiou et al., 2019 [23] | 6-yr FFS: 41% 6-yr PFS: 45% 6-yr OS: 93% 6-yr CSS: 98% 6-yr MFS: 80% | There was no difference between hemi-ablation and whole-gland treatment in terms of PFS. |
Dason et al., 2018 [26] | 5-yr RFS 51.6% | RFS 2 yr: 66.3%. No difference was seen in RFS between patients initially treated with ERBT versus brachytherapy. |
Siddiqui et al., 2017 [27] | 5-yr OS of 88%. 5-yr CSS of 94.4%. | At 53.5 ± 31.6 months follow up, the median BRFS was 63 months. At 6 months, 22/63 men had residual disease. |
Shah et al., 2016 [29] | 5-yr PFS of 31%. 5-yr OS of 87%. | Removal of PSA non-responders resulted in a 5-year PFS of 37%. Postoperative PSA nadir was significantly associated with PFS and OS. |
Kanthabalan et al., 2017 [28] | 3-yr BDFS of 48% | In PSA responders, achieving a PSA nadir of ≤0.5 ng/mL correlated with a BF rate of 12% (18/150). Redo HIFU subgroup had a 2-year BDFS of 66%. Whole gland pad free at BDFS 36 months was 78%. |
Jones et al., 2018 [25] | NA | 12-month biopsy was negative in 63 (81%) men. Mean PSA at 2 years was 1.1 ng/mL in 33 patients. |
Devos et al., 2019 [24] | 5-yr OS 80.9% 5-yr CSS 84% 5-yr MFS 60.3% | No significant differences found in S-HIFU versus S-RP for 5-year OS, CSS, and MFS. |
Crouzet et al. 2017 [20] | 7-yr OS 72%, 7-yr CSS 82%, 7-yr MFS 81%, 5-yrBRFS 49% | S-HIFU 7-year CSS and MFS rates of >80% with significant morbidity. Concluded that S-HIFU should be initiated early following EBRT failure |
Yutkin et al., 2014 [33] | 4-yr BRFS 73.6% | No significant association was found between biochemical failure, pre-HIFU Gleason score, PSA nadir, or other variables. |
Baco et al., 2014 [31] | PFS rates at 12 mo: 83%, 18 mo: 64%, and 24 mo: 52% | The D’Amico risk group before EBRT did not correlate with 18-month PFS. 18-month PFS rate was significantly associated with Gleason score during post-EBRT recurrence (≤7, 82%; ≥8, 34%; p = 0.047), and by the PSA level before HSH (≤4 ng/mL, 80%; >4 ng/mL, 49%, p = 0.002). |
Song et al., 2014 [32] | 5-yr BRFS 53.8% | BCR after salvage HIFU correlated with higher pre-EBRT PSA, pre-HIFU PSA, and short time to nadir in univariate analysis only. |
Rouvière et al., 2013 [34] | PFS was 42% at 2-yr and 31% at 4-yr | PSA level at HIFU treatment and tumor extension anterior to the urethra, as assessed by MRI, were independent predictors of salvage HIFU failure. |
Author and Year of Publication | Incontinence (General) | Sexual Function | Key Findings |
---|---|---|---|
Devos et al., 2019 [24] | 22.2% at 12 mo | NR | Complications were significantly lower in S-HIFU than S-RP, with S-HIFU patients more commonly experiencing urinary retention. Pad-dependent status differed at 22.2% for S-HIFU versus 56.0% for S-RP (p = 0.0104). |
Crouzet et al. 2017 [20] | Grade > II Initially 32%; down to 19%. | NR | With post-RT specific HIFU parameters, complication rates improved over the course of the study. Incontinence (Grade II/III) decreased from 32% to 19%; recto-urethral fistula changed from 9% to 0.6%; BOO or stenosis decreased from 30% to 15%. |
Jones et al., 2018 [25] | 47% | 12/47 maintained erectile function post S-HIFU. | Treatment related Grade III adverse events developed early in the trial and appeared related to operator experience. No life-threatening treatment-related deaths or adverse events reported. |
Kanthabalan et al., 2017 [28] | 22% | Baseline of 12/31 capable of penetration. Following treatment, 7/12 reported erection capable of penetration. | Of those who were pad-free at baseline, (42/48) remained pad-free at 2 years. UTI (11.3%), bladder neck stricture (8%), and recto-urethral fistula (8%) were the most common complications. 12/31 (38%) of patients initially reported having adequate erections for penetration, while this rate changed to 7/12 (58%) after S-HIFU. |
Siddiqui et al., 2017 [27] | IPSS significantly increased from baseline at 45 days (p < 0.001). | IIEF-5 scores significantly decreased from baseline. | No significant changes were observed. IPSS scores increased, IIEF-5 scores were reduced, while SF-36 score did not change significantly post S-HIFU. |
Siddiqui et al., 2015 [30] | 7.5% | NR | Pre-HIFU IIEF score among patients was 8.6 (±: 7.9), which disqualified them from receiving nerve-sparing treatment. Post-HIFU IIEF scores were 3.4 (±4), 5.1 (±5), and 5.4 (±6.5) at 45, 90, and 180 days, respectively. |
Shah et al., 2016 [29] | 31% | Non-significant decrease in IIEF-15 score after treatment. | Side effects with this study were equal to other salvage therapies in high-risk groups. |
Baco et al., 2014 [31] | 25% | IIEF-5 score significantly decreased from 11.2 (SD: 8.0) to 7.0 (SD: 5.8). | Average IPSS scores increased and average IIEF scores decreased after S-HIFU. ICS A and B scores increased. |
Song et al., 2014 [32] | 30.8% | NR | 4 patients reported incontinence after treatment. No observed incidence of acute urinary retention, urinary tract infection, anal incontinence, rectal injury, urethro-rectal fistula, or urethral stricture. |
Yutikin et al., 2014 [33] | 31.6% | IIEF-5 scores above 20 decreased from 4 pre-treatment to 2 at 6 month follow up. | Administration of ADT before HIFU and longer interval between BT and S-HIFU were both associated with higher complication rates. UTI was the most common complication. |
Hostiou et al., 2019 [23] | Grade I: 20/35 whole gland, 13/15 focal. Grade II-III: 15/35 whole gland, 2/15 focal. | ED rate increased from 50% to 76% from pre- to post-op. Almost half of the 25 patients with IIEF-5 scores of ≥17, were maintained at 12 months. | Incontinence, BOO and Grade ≥ III complications decreased significantly in hemi-ablation versus whole-gland intervention. |
Dason et al., 2018 [26] | NR | Median IIEF-15 score decreased from 43 pre-treatment to 19 post-treatments. | Only one complication was observed. Median IPSS increased from a baseline of 8 to 24 at a median year 1 average and 17 at a median 2-year average. |
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Sobhani, S.; Dadabhoy, A.; Ghoreifi, A.; Lebastchi, A.H. Salvage High-Intensity Focused Ultrasound for Prostate Cancer after Radiation Failure: A Narrative Review. Curr. Oncol. 2024, 31, 3669-3681. https://doi.org/10.3390/curroncol31070270
Sobhani S, Dadabhoy A, Ghoreifi A, Lebastchi AH. Salvage High-Intensity Focused Ultrasound for Prostate Cancer after Radiation Failure: A Narrative Review. Current Oncology. 2024; 31(7):3669-3681. https://doi.org/10.3390/curroncol31070270
Chicago/Turabian StyleSobhani, Sina, Anosh Dadabhoy, Alireza Ghoreifi, and Amir H. Lebastchi. 2024. "Salvage High-Intensity Focused Ultrasound for Prostate Cancer after Radiation Failure: A Narrative Review" Current Oncology 31, no. 7: 3669-3681. https://doi.org/10.3390/curroncol31070270
APA StyleSobhani, S., Dadabhoy, A., Ghoreifi, A., & Lebastchi, A. H. (2024). Salvage High-Intensity Focused Ultrasound for Prostate Cancer after Radiation Failure: A Narrative Review. Current Oncology, 31(7), 3669-3681. https://doi.org/10.3390/curroncol31070270