Focal Ablative Salvage Therapy is Safe, Effective for Recurrent Prostate Cancer

In patients with recurrent prostate cancer, focal ablative salvage therapy is associated with low incidence rates of significant adverse events and improvements in short- and medium-term oncologic control, according to a study presented at the 2022 American Urological Association Annual Meeting.

Radiotherapy is a generally effective treatment approach for non-metastatic prostate cancer, yet a portion of patients who receive this therapy experience disease recurrence, according to Deepika Reddy, MD, of the National Health Service in London, who presented the research findings.

Watchful waiting and systemic therapy are the typical strategies for managing patients with recurrent disease, stated Dr. Reddy and colleagues, given the “significant urinary and rectal morbidity resulting from salvage prostatectomy.”  In contrast, focal ablative salvage therapy (FAST) may confer good oncological control with fewer rates of adverse effects.

In their study, Dr. Reddy and colleagues analyzed outcomes following FAST using cryotherapy or high-intensity focused ultrasound (HIFU). The study included a total of 288 consecutive patients from 8 sites within the UK’s HEAT and ICE prospective registries. Between the years 2006 and 2020, patients had prostate cancer recurrence after radiotherapy and underwent FAST.

Approximately 76.5% (n=221) of patients underwent HIFU, while 23.2% (n=67) underwent cryotherapy for mostly anterior or T3b disease. A total of 265 cases had available follow-up data eligible for the final analysis. The median age of the population was 70 years, while the median prostate-specific antigen was 5.3 ng/ml (3.3-8.2).

Around 65% (n=118) and 24% (n=68) of patients had rT2 and rT3 disease, respectively. The proportions of patients classified into International Society of Urological Pathology Grade Groups 2, 3 and >3 were 36.5%, 30.9%, and 21.5%, respectively.

The primary outcome of failure-free survival (FFS) was defined as the avoidance of systemic therapy, whole-gland treatment, metastases, or prostate cancer-specific death. Additional secondary outcomes included retreatment-free survival, overall survival (OS), and adverse events.

The 6-year FFS was 77%, and the 6-year retreatment-free survival was 77%. (Figures 1 and 2) Additionally, the OS rate at 6 years was 82%. Only 7.3% (n=21) of patients experienced adverse events. A patient (0.3%) received management for fistula formation; nearly 6% (n=7) of patients received treatment for urine infections, and a single patient (0.3%) received management for hematuria as an outpatient.