title: Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy.
abstract: OBJECTIVE
  To report our experience with salvage high-intensity focused ultrasound (HIFU) in patients with local failure after brachytherapy for prostate cancer.
  
  
  METHODS
  Whole-gland HIFU was administered to prospectively recruited patients with local histologic failure after brachytherapy at 2 institutions in the United Kingdom and Canada. Functional and oncologic outcomes of the procedure were analyzed.
  
  
  RESULTS
  Nineteen patients underwent the treatment, 12 with Gleason sum 7 and 5 with Gleason sum 8 at recurrence. Thirteen men had grade-3a or -3b complications by the Clavien system; there were no grade-4 or -5 complications. The most common postoperative complication was dysuria, which was self-limited. Three men developed rectourethral fistulae. The overall continence rate was 68.4%. At a mean follow-up of 51.6 months, all men were alive. The overall biochemical recurrence-free survival rate was 66.7% and 73.3% using the "nadir prostate-specific antigen level" +1.3 ng/mL and +2 mg/ml criteria, respectively. This study is limited by the small cohort size, relatively short follow-up period, and heterogeneity of the patient population.
  
  
  CONCLUSIONS
  In this, the largest prospective series to date, we demonstrate that salvage HIFU for locally recurrent prostate cancer after failed primary brachytherapy has encouraging disease control results, albeit with a relatively high complication rate.
authors.affiliation: Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Yutkin
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom.
authors.forename: Hashim U
authors.initials: HU
authors.lastname: Ahmed
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Donaldson
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: McCartan
authors.affiliation: Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
authors.forename: Khurram
authors.initials: K
authors.lastname: Siddiqui
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
authors.affiliation: Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada. Electronic address: joseph.chin@lhsc.on.ca.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D018572:Disease-Free Survival; D053159:Dysuria / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000379:methods*