BACKGROUND: Treatment options for radio-recurrent prostate cancer are either androgen-deprivation therapy or salvage
prostatectomy. Whole-gland high-intensity focussed ultrasound (HIFU) might have a role in this setting.
METHODS: An independent HIFU registry collated consecutive cases of HIFU. Between 2005 and 2012, we identified 50 men who
underwent whole-gland HIFU following histological confirmation of localised disease following prior external beam radiotherapy
(2005–2012). No upper threshold was applied for risk category, PSA or Gleason grade either at presentation or at the time of failure.
Progression was defined as a composite with biochemical failure (Phoenix criteria (PSA4nadir+2 ng ml − 1
)), start of systemic
therapies or metastases.
RESULTS: Median age (interquartile range (IQR)), pretreatment PSA (IQR) and Gleason score (range) were 68 years (64–72),
5.9 ng ml − 1 (2.2–11.3) and 7 (6–9), respectively. Median follow-up was 64 months (49–84). In all, 24/50 (48%) avoided androgendeprivation
therapies. Also, a total of 28/50 (56%) achieved a PSA nadir o0.5 ng ml − 1
, 15/50 (30%) had a nadir ⩾ 0.5 ng ml − 1 and
7/50 (14%) did not nadir (PSA non-responders). Actuarial 1, 3 and 5-year progression-free survival (PFS) was 72, 40 and 31%,
respectively. Actuarial 1, 3 and 5-year overall survival (OS) was 100, 94 and 87%, respectively. When comparing patients with PSA
nadir o0.5 ng ml − 1
, nadir ⩾0.5 and non-responders, a statistically significant difference in PFS was seen (Po0.0001). Three-year
PFS in each group was 57, 20 and 0%, respectively. Five-year OS was 96, 100 and 38%, respectively. Early in the learning curve,
between 2005 and 2007, 3/50 (6%) developed a fistula. Intervention for bladder outlet obstruction was needed in 27/50 (54%).
Patient-reported outcome measure questionnaires showed incontinence (any pad-use) as 8/26 (31%).
CONCLUSIONS: In our series of high-risk patients, in whom 30–50% may have micro-metastases, disease control rates were
promising in PSA responders, however, with significant morbidity. Additionally, post-HIFU PSA nadir appears to be an important
predictor for both progression and survival. Further research on focal salvage ablation in order to reduce toxicity while retaining
disease control rates is required.