title: Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients.
abstract: To report the oncological outcome of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre database.
  
  
  
  This retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S-HIFU from 1995 to 2009. The biochemical failure-free survival (bFFS) rate was based on the 'Phoenix' definition (PSA nadir + 2 ng/mL). Secondary endpoints included progression to metastasis and cancer-specific death. Kaplan-Meier analysis was performed examining overall (OS), cancer-specific (CSS) and metastasis-free survival (MFS). Adverse events and quality of life status are reported.
  
  
  
  In all, 418 patients with a mean (SD) follow-up of 3.5 (2.5) years were included. The mean (SD) age was 68.6 (5.8) years and the PSA level before S-HIFU was 6.8 (7.8) ng/mL. The median PSA nadir after S-HIFU was 0.19 ng/mL. The OS, CSS and MFS rates at 7 years were 72%, 82% and 81%, respectively. At 5 years the bFFS rate was 58%, 51% and 36% for pre-EBRT low-, intermediate- and high-risk patients, respectively. The 5-year bFFS rate was 67%, 42% and 22% for pre-S-HIFU PSA level ≤4, 4-10 and ≥10 ng/mL, respectively. Complication rates decreased after the introduction of specific post-RT parameters: incontinence (grade II or III) from 32% to 19% (P = 0.002); bladder outlet obstruction or stenosis from 30% to 15% (P = 0.003); recto-urethral fistula decreased from 9% to 0.6% (P < 0.001). Study limitations include being a retrospective analysis from a registry with no control group.
  
  
  
  S-HIFU for locally recurrent prostate cancer after failed EBRT is associated with 7-year CSS and MFS rates of >80% at a price of significant morbidity. S-HIFU should be initiated early following EBRT failure.
authors.affiliation: Department of Urology, Edouard Herriot Hospital, Lyon, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Crouzet
authors.affiliation: Department of Urology, Fuerth Hospital, Fürth, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Blana
authors.affiliation: Urology Department, Val d'Ouest Hospital, Ecully, France.
authors.forename: Francois J
authors.initials: FJ
authors.lastname: Murat
authors.affiliation: Department of Urology, CHU Pellegrin, Bordeaux, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Pasticier
authors.affiliation: Department of Urology, Stepping Hill Hospital, Stockport, UK.
authors.forename: Stephen C W
authors.initials: SCW
authors.lastname: Brown
authors.affiliation: Department of Urology, St. Anna Hospital, Como, Italy.
authors.forename: Giario N
authors.initials: GN
authors.lastname: Conti
authors.affiliation: Department of Urology, University of Regensburg, Regensburg, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Ganzer
authors.affiliation: Department of Radiation Oncology, Lyon Sud Hospital, Pierre Bénite, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chapet
authors.affiliation: Department of Urology, Edouard Herriot Hospital, Lyon, France.
authors.forename: Albert
authors.initials: A
authors.lastname: Gelet
authors.affiliation: Department of Urology, University of Regensburg, Regensburg, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Chaussy
authors.affiliation: Department of Urology, Duke University, Durham, NC, USA.
authors.forename: Cary N
authors.initials: CN
authors.lastname: Robertson
authors.affiliation: Department of Urology, Harlaching Hospital, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Thuroff
authors.affiliation: Department of Urology, M. D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Ward
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D017211:Treatment Failure; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects
keywords: 
  PSA
  ; #ProstateCancer; biochemical failure; follow-up; high-intensity focused ultrasound; salvage therapy