[Locally recurrent prostatic adenocarcinoma after exclusive radiotherapy: results of high intensity focused ultrasound].
OBJECTIVE
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.


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+/-7.26ng/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 0.10ng/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.
Poissonnier
L
L
Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Edouard-Herriot, université Claude-Bernard de Lyon-1, 5, place d'Arsonval, Lyon 69003, France.
Murat
F-J
FJ
Belot
A
A
Bouvier
R
R
Rabilloud
M
M
Rouviere
O
O
Chapelon
J-Y
JY
Gelet
A
A
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D001918:Brachytherapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D016879:Salvage Therapy; D017211:Treatment Failure; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000295:instrumentation / Q000379:methods