High-intensity focused ultrasound (HIFU): our experience in the treatment of prostate cancer relapsing after radiotherapy

The aim of the study is to evaluate the safety and efficacy of high-intensity focused ultrasound (HIFU) treatment in patients with local prostate cancer recurrence after radiotherapy. From February 2009 to June 2010, 14 patients with prostate cancer recurrence after radiotherapy were selected for HIFU treatment; all patients had a positive TRUS-guided biopsy and the absence of distant metastases was confirmed by computer tomography, PET choline or bone scintigraphy. We classified all patients in 3 groups using D'Amico's classification: 4 patients high risk (PSA > 20 ng/ml - 8 = Gleason Score <= 10 - clinical stage >= T2c), 8 patients intermediate risk (10 < PSA <= 20 ng/ml - Gleason Score= 7 - clinical stage= T2b), and 2 patients low risk (PSA <= 10 ng/ ml - Gleason Score <= 6 - clinical stage= T1c- T2a). Progression was defined using Stuttgart definition (PSA> PSAnadir+ 1.2ng/ ml) or after adjuvant therapy introduction. All complications were recorded. Of the 14 patients selected, 12 patients underwent HIFU treatments; 2 patients were excluded because of rectal strictures induced by radiotherapy. At a mean 13 months' follow- up, biochemical success rate was obtained in 1 of the high risk patients and in 5 of the low and intermediate risk patients; 1 man died for a disease not correlated with prostate cancer recurrence. Complications included urinary tract infection, acute urinary retentions, urethral strictures and light stress incontinence. In our experience salvage HIFU is a safe treatment option for local relapse after radiotherapy; its efficacy depends on a careful patient selection.