Richard Lotenfoe

High- Intensity Focused Ultrasound as a Salvage Therapy for Patients with Recurrent Prostate Cancer



Posted: Wednesday, March 23, 2011

by Richard Lotenfoe
orlando urologist

Men who have tried External Beam Radiation Therapy (EBRT) or Interstitial Brachytherapy for clinically localized prostate cancer possess a 20-30% greater probability of having prostate-specific antigen (PSA) failure. Salvage therapy is indicated when men are treated with radiotherapy, brachytherapy, or a combination of these for presumed localized prostate cancer and have a recurrence. The success rates after salvage procedures are considerably less than those that have been reported after more fundamental treatments. The results of the use of HIFU as a salvage therapy for patients with recurrent prostate cancer have been good, with negative biopsy rates as elevated as 80% and 61% achieving a PSA nadir of <0.5 µg/L (n = 71); 44% were reported as freed from biochemical relapse at the follow up exam, at an average follow-up of 14.8 (6-86) months.

To analyze the usage of high-intensity focused ultrasound (HIFU) as a salvage therapy in patients with a recurrence of localized prostate cancer after external beam radiation (EBRT), brachytherapy, or proton therapy, the charts of all patients who had undergone salvage HIFU for biopsy-proven prostate cancer after primary radiation therapy, were reviewed retrospectively. Patient characteristics and oncological effects were assessed

Records of 22 patients with a median (range) follow-up of 24 (5-80) months were reviewed. Patients were men with presumed organ-confined disease who were treated with salvage HIFU following recurrent disease after EBRT (fourteen patients), brachytherapy (five patients: four with high-dose brachytherapy using In (192); and one with low-dose brachytherapy applying Au (98)) or proton therapy (three patients). The median (range) age at salvage HIFU was 65 (52-80) years, with a median (range) prostate-specific antigen (PSA) level before radiation therapy of 14.3 (5.7-118) ng/mL and an average (range) PSA level of 4.0 (1.2-30.1) ng/mL before HIFU. The median (range) period to HIFU after radiation therapy was 36 (4-96) months. The biochemical disease-free survival (bDFS) rate in all patients at 5 years was 52%. Rates of bDFS in low-, intermediate- and high-risk groups were 100%, 86%, and 14%, respectively. One among the twelve patients who received post-HIFU prostate biopsy showed malignancy. Side effects included urethral stricture in four patients, grade I urinary incontinence in four patients, rectourethral fistula and epididymitis in one of each patient.

This preliminary data recommend that high intensity focused ultrasound represents a legitimate alternative treatment strategy for patients with localized prostate cancer. Salvage HIFU is often a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other types of salvage treatment. A careful choice by the patient is imperative depending upon the aforementioned prognostic factors.
Richard R. Lotenfoe, MD, is a Fellow of the American College of Surgeons and Board Certified Urological Surgeon in Orlando, Florida. He specializes in the treatment of prostate cancer using the HIFU procedure.

Dr. Richard R. Lotenfoe is the Founder of Orlando-based Urology Health Solutions Inc., and CEO of Innovative Technologies, LLC. He is regarded by many of his fellow surgeons as a pioneer in Urology in the State of Florida and the United States. Since establishing his Orlando practice in 1999, he has been firmly committed to embracing minimally invasive technology and perfecting the latest urological surgical techniques. Since 1994 he has been one of a select group of Urological Surgeons in the United States skilled enough to offer the latest surgical procedures to his patients, which improve surgical outcomes, while minimizing pain and discomfort associated with traditional surgeries.

http://www.hifucare.com
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