SALVAGE HIGH INTENSITY FOCUS ULTRASOUND (HIFU) FOLLOWING PRIMARY BRACHYTHERAPY FOR PROSTATE CANCER: CASE REPORT AND LITERATURE REVIEW

Carmen Maccagnano1, Antonello Paulesu1, Matteo Corinti1, Alfonso D'Onofrio1, Giario Natale Conti1
  • 1 ASST Lariana Ospedale Sant'Anna (San Fermo della Battaglia)

Objective

The treatment of recurrent disease following primary brachytherapy (BT) for localized prostate cancer (PCa) is possible but nothing about this field is described in literature. Theoretical therapeutic options may include salvage prostatectomy, salvage radio-therapy,  hormonal therapy, observation and salvage HIFU.

Materials and Methods

We report our experience with one patient with PCa treated with BT and retreated with HIFU because of local recurrence.
We search in Medline using the key words “prostate cancer”, “prostate barchytherapy”, “salvage High Intensity Focus Ultrasound”.

Results

69 year-old man, treated with BT because of prostatic adenocarcinoma Gleason 3 + 3 in another center. The patient did not describe any short- or long term complications, except erectile dysfunction. PSA progressively increased during years after the procedure, until it reaches 5.35 ng/mL.
Thus, the patient executed HIFU. There were no short- or long term complications. The man described mild urgency but no urinary incontinence. The PSA nadir was 0.48 ng/mL, 6 months after the salvage HIFU. The last PSA, 24 months after the treatment, was 0.48 ng/mL. No androgenic blockade was administered. He is still on follow-up.
We did not find any paper about the sequential employment of BT and HIFU for the treatment of PCa.

Discussions

SEE RESULTS

Conclusion

Salvage HIFU after BT is feasible, without significant short- and long term complications. It allows a good control of PCa, granting a good quality of life for the patient. More trials are necessary to obtain some definitive conclusions. HIFU represents a chance of curing patients who refused surgery or are preferable not to be administered with androgenic blockade.

Reference

1. Yutkin V, Ahmed HU, Donaldson I, McCartan N, Siddiqui K, Emberton M, Chin JL. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. Urology 2014; 84(5):1157-62
2. Taneja SS. Re: Salvage High-Intensity Focused Ultrasound for Patients with Recurrent Prostate Cancer after Brachytherapy. J Urol 2015; 194(1).
3, Uchida T, Shoji S, Nakano M, Hongo S, Nitta M, Usui Y, Nagata Y.High-intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after external beam radiation, brachytherapy or proton therapy. BJU Int 2011; 107(3): 378-82.

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