SALVAGE HIGH INTENSITY FOCUS ULTRASOUND (HIFU) FOLLOWING PRIMARY HIFU FOR PROSTATE CANCER HAS TO BE CONSIDERED AS AN ALTERNATIVE TREATMENT FOR RECURRENCE
Recurrent disease following primary high intensity focus ultrasound (HIFU) 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 three patients with PCa treated with HIFU and retreated with HIFU because of local recurrence. We also reviewed the literature, searching for the key words: “Prostate Cancer Recurrence”, “Focal Therapy”, “High Intensity Focus Ultrasound” and “Salvage Therapy”.
Case 1. 69 year-old man, treated with trans-urethral resection of prostate (TURP) and HIFU because of prostate adenocarcinoma (ADK) Gleason 3 + 3, PSA 3.07 ng/mL. There were no short- or long term complications. PSA progressively increased during years after the procedure, until it reaches 5.94 ng/mL. He executed a Coline PET-CT with evidence of captation in the right lobe. A multi- parametric Magnetic Resonance Imaging documented a lesion with diameters pf 15 X 9 X 13 mm, in right median paramedian zone, with PI-RADS 5. Thus, the patient executed HIFU only in the right lobe. There were no short- or long term complications. The man described only mild urgency. The last PSA was 0.47 ng/mL, 20 months after the salvage HIFU.
Case 2. 64 year-old man, treated with trans-urethral resection of prostate (TURP) and HIFU because prostate ADK Gleason 3 + 3, PSA 2.98 ng/mL. Additionally, the pathological report after TURP evidenced a prostate ADK Gleason 3 + 3 in the transitional zone, in < 5% of the specimens. There were no short- or long term complications. Six years after the first HIFU the patient executed a prostate biopsy, with a PSA of 0,57 ng/mL. The pathological report documented a single core with prostate ADK Gleason 3 + 3, located in a different zone of the prostate comparing with the first biopsy. There were no short- or long term complications. The last PSA was 0.93 ng/mL, 26 months after the salvage HIFU.
Case 3. 60 year-old man, treated with HIFU because prostate ADK Gleason 3 + 3, PSA of 6,4 ng/mL. The man reported significant pain during micturion and recurrent prostatitis; thus he used the sovrapubic catheter during 2 moths after the procedure. 48 months after HIFU,PSA was 1,28 ng/mL. Thus, the patient executed a second biopsy, with diagnosis of prostate ADK Gleason 4 + 4 in the left lobe. He executed salvage HIFU, describing urgency during the following months. 12 months after the second HIFU PSA was 4,05 ng/mL. Thus he underwent Imaging Modulated RadioTherapy with a total dose of 70 Gy. The last PSA was 2,38, with a colice CT-PET without recurrence. He is still in follow-up, still reporting urgency.
No androgenic blockade was administered in all the cases.
Salvage HIFU is a feasible and therapeutic option for PCa recurrence after primary HIFU, with no or mild complications. It should be considered for patients who refuse surgery or radiotherapy, or for who with contraindications for androgenic blockade. More trials are necessary to confirm these preliminary data.
NONEArgomenti: cancro della prostata