Prognostic Factors For Salvage HIFU Success After External Beam Radiation Failure

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 15 Jun 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - HIFU is a potentially curative treatment for locally recurrent prostate cancer after external beam radiation therapy (EBRT). A group of French investigators evaluated the prognostic factors for disease progression after salvage HIFU.

Patients with biopsy-proven local recurrence and no detectable metastasis following EBRT were offered HIFU. Disease progression was defined according to the Phoenix criteria: PSA nadir + 2ng/ml OR positive biopsy OR initiations of further salvage treatment. The progression-free survival rate (PFSR) was stratified according to the pre-HIFU Gleason score and PSA level, the pre-HIFU positive biopsy percentage, the pre EBRT D'Amico's risk group, and the administration of androgen deprivation (AD) at the time of RT or between recurrence and HIFU. Univariate and multivariate analysis were calculated using Kaplan-Meier curves and Cox Model, respectively.

167 patients with a mean age of 68.9 years underwent salvage HIFU. Mean Follow-up was 18.1 months (3-122). Systematic follow-up biopsies were negative in 73% and the median PSA nadir was 0.19 ng/ml. The overall actuarial 5-year survival rate was 84%. PFSR was inversely related to the pre-RT risk group (p=0.002) with 53%, 42% and 25% at 3 years for low, intermediate and high risk patients, respectively. PFSR was significantly lower (p<0.0001) in patients who received AD, even when stratified within risk group (p=0.0001). Neither the Gleason sum (p=0.2) nor the positive biopsy percentage (p=0.18) influenced the PFSR. In multivariate analysis, the risk ration for high and intermediate risk classification was 1.96 and 1.32, respectively. It was 2.8 when AD was used.

They conclude that patients most likely to benefit from a HIFU salvage therapy have pre-RT low or intermediate disease. The pre-HIFU biopsy information has little influence on the efficacy of salvage HIFU. Surprisingly, patients who are hormonally naive are much better responders than others. They suggest that further study is needed.

Presented by Francois-Joseph Murat, MD, Laura Poissonnier, MD, Marc Colombel, MD, Xavier Martin, MD, Jean-Yves Chapelon, MD, and Albert Gelet, MD at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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