title: Pathological, Oncologic and Functional Outcomes of a Prospective Registry of Salvage High Intensity Focused Ultrasound Ablation for Radiorecurrent Prostate Cancer.
abstract: In this prospective registry we prospectively assessed the oncologic, functional and safety outcomes of salvage high intensity focused ultrasound for radiorecurrent prostate cancer.
  
  
  
  A total of 81 men were prospectively recruited and evaluated at regular scheduled study visits to 6 months after high intensity focused ultrasound and thereafter as per standard of care. Transrectal ultrasound guided biopsy was performed at 6 months. The primary end point was absence or histological persistence of disease at 6-month biopsy. Secondary end points included quality of life, biochemical recurrence-free survival, overall survival, cancer specific survival and progression to androgen deprivation therapy. Survival analysis was performed according to the Kaplan-Meier method and multivariate analysis was performed using the log rank (Mantel-Cox) test.
  
  
  
  Mean ± SD prostate specific antigen before high intensity focused ultrasound was 4.06 ± 2.88 ng/ml. At 6 months 63 men underwent biopsy, of whom 22 (35%) had residual disease. At a mean followup of 53.5 ± 31.6 months median biochemical recurrence-free survival was 63 months. The 5-year overall and cancer specific survival rates were 88% and 94.4%, respectively. Nadir prostate specific antigen less than 0.5 ng/ml was a significant predictor of biochemical recurrence-free survival (p=0.014, 95% CI 1.22-5.87). I-PSS significantly increased (p <0.001) while IIEF-5 scores decreased and the SF-36 score did not change significantly. The rate of rectal fistulization and severe incontinence was 3.7% each. A total of 223 complications were recorded in the 180 days after high intensity focused ultrasound (Clavien-Dindo grade 1-195, grade II-20, grade III-7, grade IVa-1).
  
  
  
  Salvage high intensity focused ultrasound appears to be a viable treatment option for radiorecurrent prostate cancer, with acceptable morbidity.
authors.affiliation: Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
authors.forename: Khurram M
authors.initials: KM
authors.lastname: Siddiqui
authors.affiliation: Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
authors.forename: Michele
authors.initials: M
authors.lastname: Billia
authors.affiliation: Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Arifin
authors.affiliation: Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
authors.forename: Fan
authors.initials: F
authors.lastname: Li
authors.affiliation: Woodstock Hospital, Woodstock, Ontario, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Violette
authors.affiliation: Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D018572:Disease-Free Survival; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: high-intensity focused ultrasound ablation; prostatic neoplasms; radiotherapy; recurrence; salvage therapy