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Review
. 2020 Jun;9(3):1535-1545.
doi: 10.21037/tau.2019.08.21.

A systematic review of salvage focal therapies for localised non-metastatic radiorecurrent prostate cancer

Christopher C Khoo  1   2 , Saiful Miah  1   2   3 , Martin J Connor  1 , Joseph Tam  1 , Mathias Winkler  1   2 , Hashim U Ahmed  1   2 , Taimur T Shah  1   2   3
Affiliations
Review

A systematic review of salvage focal therapies for localised non-metastatic radiorecurrent prostate cancer

Christopher C Khoo et al. Transl Androl Urol. 2020 Jun.

Abstract

Although radiotherapy to the prostate for cancer is effective, recurrence occurs in 10-15% within 5 years. Traditional salvage treatments for men with radiorecurrent prostate cancer comprise of watchful waiting (WW) with or without androgen deprivation therapy (ADT) or radical prostatectomy (RP). Neither strategy provides ideal therapeutic ratios. Salvage focal ablation is an emerging option. We performed a systematic review of the Medline and Embase databases for studies reporting outcomes of focal salvage brachytherapy (sBT), cryotherapy (sCT) or high-intensity focused ultrasound (sHIFU) for radiorecurrent prostate cancer (conception to April 2019). Results were screened for inclusion against predetermined eligibility criteria. Certain data were extracted, including rates of biochemical disease-free survival (BDFS), metastasis, conversion to second-line therapies and adverse events. Of a total 134 articles returned from the search, 15 studies (14 case series and 1 comparative study) reported outcomes after focal sBT [5], sCT [7] and sHIFU [3]. Cohort size varied depending on intervention, with eligible studies of sBT being small case series. Median follow-up ranged from 10 to 56 months. Although pre-salvage demographics were similar [median age range, 61-75 years; prostate-specific antigen (PSA) range, 2.8-5.5 ng/mL], there was heterogeneity in patient selection, individual treatment protocols and outcome reporting. At 3 years, BDFS ranged from 61% to 71.4% after sBT, 48.1-72.4% after sCT and 48% after sHIFU. Only studies of sCT reported 5-year BDFS, which ranged from 46.5% to 54.4%. Rates of metastasis were low after all salvage modalities, as were conversion to second-line therapies (although this was poorly reported). Grade 3 adverse events were rare. This systematic review indicates that salvage focal ablation of radiorecurrent prostate cancer provides acceptable oncological outcomes and is well tolerated. Unfortunately, there is heterogeneity in the study design of existing evidence. Level 1 research comparing salvage focal therapies to existing whole-gland strategies is needed to further establish the role of these promising treatments.

Keywords: Prostate cancer; brachytherapy; cryotherapy; high-intensity focused ultrasound (HIFU); salvage therapy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tau.2019.08.21). The series “Prostate Imaging and Focal Therapy” was commissioned by the editorial office without any funding or sponsorship. MJC, SM, TTS and HUA served as the unpaid Guest Editors of the series. MW receives a travel grant and a loan of device from Zicom Biobot. MJC is funded by the Wellcome Trust. TTS would like to acknowledge funding from Prostate Cancer UK and the St Peters Trust for clinical research and has received funding for conference attendance from Astellis, Ferring and Galil Medical. HUA’s research is supported by core funding from the United Kingdom’s National Institute of Health Research (NIHR) Imperial Biomedical Research Centre. HUA currently receives funding from the Wellcome Trust (grant 204998/Z/16/Z), Prostate Cancer UK, Sonacare Inc., MRC, Cancer Research UK, Imperial Health Charity, BMA Foundation, The Urology Foundation, Trod Medical and Sophiris Biocorp for trials in prostate cancer. Ahmed is a paid medical consultant for Sophiris Biocorp, BTG/Galil and Sonacare Inc. Ahmed is a paid proctor for HIFU and cryotherapy and Rezum water therapy and is paid for training other surgeons in these procedures. The other authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study selection.
See this image and copyright information in PMC

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