Trials explore new forms of salvage therapy following first-line radiotherapy
Posted Sep 28 2008 5:40pm
Poissonnier et al. have demonstrated the potential of high-intensity focused ultrasound (HIFU) and Jamal et al. have published a report on the first use of robot-assisted laparoscopic radical prostatectomy (RALP) as salvage therapy following the failure of external beam radiotherapy (EBRT) in first-line treatment of localized prostate cancer.
In the first situation, Poissonier and his colleagues set out to determine the efficacy and adverse effects of HIFU in treatment of local recurrence of prostate cancer after EBRT. They treated 72 patients with histologically and biologically documented local recurrence after radiotherapy. The mean age of the patients was 68.27 ± 5.93 years, and their mean PSA was 6.64 ± 7.26 ng/mL. ASTRO 2005 criteria, specific for salvage therapy (Phoenix consensus), were used to define recurrence. Progression-free survival was calculated by the Kaplan-Meier method.
The mean patient follow-up was 39 ± 28 months; the negative biopsy rate was 80 percent; and the median nadir PSA was 0.10 ng/mL. Disease-specific survival was 94 percent at 3 years and 90 percent at 5 years. Progression-free survival was 50 percent at 3 years and 44 percent at 5 years. Adverse events of HIFU in these patients were significant: urinary incontinence occurred in 44% percent of patients and urethral stricture or bladder neck stenosis in 30 percent. The authors conclude that although treatment with HIFU achieved a 5-year progression-free survival of 44 percent, patients need to be clearly informed about the high rate of adverse effects.
In the second study, Jamal et al. successfully completed the first case of salvage RALP for local recurrence after EBRT. The patient was a 50-year-old man who initially underwent combined EBRT with hormonal treatment for stage T2a prostate cancer. His original PSA level was 10.5 ng/mL, and his biopsy Gleason score was 3 + 3 = 6. Two years later, he developed biopsy-proven recurrent disease and was treated with RALP. The patient was discharged on day 1 postoperatively. Histologic analysis revealed an organ-confined tumor. His PSA 3 months post-surgery was <0.03 ng/mL, and he was continent. In appropriately experienced hands it appears that salvage RALP is a safe and technically feasible treatment for selected prostate cancer patients who have failed first-line EBRT.
Poissonnier et al. have demonstrated the potential of high-intensity focused ultrasound (HIFU) and Jamal et al. have published a report on the first use of robot-assisted laparoscopic radical prostatectomy (RALP) as salvage therapy following the failure of external beam radiotherapy (EBRT) in first-line treatment of localized prostate cancer.
In the first situation, Poissonier and his colleagues set out to determine the efficacy and adverse effects of HIFU in treatment of local recurrence of prostate cancer after EBRT. They treated 72 patients with histologically and biologically documented local recurrence after radiotherapy. The mean age of the patients was 68.27 ± 5.93 years, and their mean PSA was 6.64 ± 7.26 ng/mL. ASTRO 2005 criteria, specific for salvage therapy (Phoenix consensus), were used to define recurrence. Progression-free survival was calculated by the Kaplan-Meier method.
The mean patient follow-up was 39 ± 28 months; the negative biopsy rate was 80 percent; and the median nadir PSA was 0.10 ng/mL. Disease-specific survival was 94 percent at 3 years and 90 percent at 5 years. Progression-free survival was 50 percent at 3 years and 44 percent at 5 years. Adverse events of HIFU in these patients were significant: urinary incontinence occurred in 44% percent of patients and urethral stricture or bladder neck stenosis in 30 percent. The authors conclude that although treatment with HIFU achieved a 5-year progression-free survival of 44 percent, patients need to be clearly informed about the high rate of adverse effects.
In the second study, Jamal et al. successfully completed the first case of salvage RALP for local recurrence after EBRT. The patient was a 50-year-old man who initially underwent combined EBRT with hormonal treatment for stage T2a prostate cancer. His original PSA level was 10.5 ng/mL, and his biopsy Gleason score was 3 + 3 = 6. Two years later, he developed biopsy-proven recurrent disease and was treated with RALP. The patient was discharged on day 1 postoperatively. Histologic analysis revealed an organ-confined tumor. His PSA 3 months post-surgery was <0.03 ng/mL, and he was continent. In appropriately experienced hands it appears that salvage RALP is a safe and technically feasible treatment for selected prostate cancer patients who have failed first-line EBRT.
Filed under: Management, Treatment