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Prostate Cancer
treatment of PCa. The long-term oncological results require further Radiofrequency Ablation
study, and studies using the Sonablate device for primary and Radiofrequency interstitial tumour ablation (RITA) has been used in a
salvage therapy are in progress at our institution. This device number of tumours as a non-invasive ablative therapy. Using TRUS
potentially has the advantage of being able to deliver visually directed guidance, RITA causes targeted tissues to be heated and destroyed by
therapy, which can safely include the whole apex. Quality of life coagulative necrosis, much like HIFU. It has been tested in primary
studies are also required to establish the acceptance of HIFU treatment PCa,
24–26
and recently a small group of EBRT-failure patients was treated
with both devices among patients. with this technique.
27
Although 90% of patients experienced a decrease
in PSA of >50% and 46% a decrease of >80%, the authors did not report
Salvage Brachytherapy any patients with undetectable levels of PSA and only one patient had a
Seed implant brachytherapy has been used in a few studies of patients sustained decrease in PSA of >80%. While this may be due to the focal
who have developed biochemical recurrence after EBRT. The two nature of their treatment strategy, the impression given is that this
major series give five-year bDFS rates of 34–53%.
21,22
In the larger technique is less effective than other minimally invasive salvage therapies.
series, Grado et al. reported a 98% local cancer control rate and
disease-specific survival rates of 89 and 79% at three and five years, Conclusions
Minimally invasive therapies for radiorecurrent PCa are evolving and
have more or less replaced salvage radical prostatectomy in the UK.
Minimally invasive therapies for
Careful patient selection for salvage therapy is crucial and thorough
radiorecurrent prostate cancer
staging will allow high-risk patients to be identified. LLND may play a
role above imaging in identifying high-risk cases that may still be
are evolving and have more or
curable. Cryotherapy and HIFU appear to be the most promising
less replaced salvage radical
salvage therapies. The advantages and disadvantages of the various
delivery systems may influence the efficacy and side effect profile of
prostatectomy in the UK.
each treatment. Direct comparative studies would be ideal, but are
unlikely to take place. With respect to HIFU, visually directed therapy
respectively. Recently, a small series of 17 cases showed an actuarial appears to give greater efficacy compared with algorithm-driven
four-year survival of 75%, with no prostate cancer deaths or local therapy, and this may favour the Sonablate device. One of the
recurrences. Grade III and IV genito-urinary toxicity developed in seven limitations of current studies is the lack of consensus with respect to
patients (41%) and one patient (6%), respectively. Grade II and III the definition of failure after ablative therapy (primary or salvage). It is
gastrointestinal toxicity occurred in five patients (29%) and one not clear whether the same measures should be used for HIFU and
patient (6%), respectively.
23
Thus, salvage brachytherapy appears to be cryotherapy; this question needs the same attention that failure after
a potentially useful salvage therapy that requires further evaluation. radiotherapy has received from ASTRO. ■
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18 EUROPEAN GENITO-URINARY DISEASE 2007