Locally recurrent prostatic adenocarcinoma after exclusive radiotherapy: Results high intensity focused ultrasound

Objectives. - To determine the efficacy and adverse effects of high intensity focused ultrasound (HIFU) for the treatment of local recurrence of prostate cancer after exclusive external beam radiotherapy. Material and methods. - Seventy-two patients with histologically and biologically documented Local recurrence after radiotherapy were treated by HIFU. The mean age was 68.27 +/- 5.93 years, and mean PSA was 6.64 +/- 7.26 ng/ml. Thirty patients were treated according to standard parameters and 42 according to specific parameters. ASTRO 2005 criteria, specific for salvage therapy (Phoenix consensus), were used to define recurrence. Progression-free survival was calculated by the Kaplan-Meier method. Results. - Mean follow-up was 39 28 months. The negative biopsy rate was 80% and the median nadir PSA was 0.10 ng/ml. Specific survival was 94% at three years and 90% at five years, and progression-free survival was 50% at three years and 44% at five years. The urinary incontinence rate was 44% (grade 1 : 12%, grade 2/3 : 32%) and the urethral stricture or bladder neck stenosis rate was 30%. The use of specific parameters reduced the incidence of severe incontinence (19% versus 50, P=0.005) and stenosis (24% versus 40). Conclusions. - Treatment with HIFU achieved a five-year progression-free survival of 44%, but patients must be clearly informed about the high rate of adverse effects. (C) 2008 Elsevier Masson SAS. Tous droits reserves.