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Perennec T, Rogé M, Hetet JF, Colls P, Guimas V, Rio E, Vaugier L, Supiot S. Salvage prostate intensity modulated radiation therapy after cryotherapy failure. Sci Rep 2024; 14:9148. [PMID: 38644367 PMCID: PMC11033268 DOI: 10.1038/s41598-024-59406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024] Open
Abstract
Cryotherapy is an ablative therapy that can be used to treat localized prostate cancer. In case of recurrence, treatment options are not well-defined, and their outcomes are unknown. We therefore collected all patients treated with radiotherapy after cryotherapy for prostate cancer recurrence in Nantes (France) between 2012 and 2019. We identified ten patients. After a median follow-up of 5 years, two patients presented late grade 3 toxicities; one patient presented a grade 3 rectal hemorrhage, and one had a grade 3 hematuria. Two patients relapsed at 61 and 62 months, and three patients died of other causes. Radiotherapy to treat local prostate cancer recurrence after cryotherapy seems feasible and effective in local control. These results do not allow us to recommend this technique in current practice but are encouraging for the conduct of prospective trials.
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Affiliation(s)
- Tanguy Perennec
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France.
| | - Maximilien Rogé
- Department of Radiation Oncology, Centre Henri Becquerel, 1 Rue d'Amiens, 76000, Rouen, France
| | - Jean-François Hetet
- Department of Urology, Clinique Jules Verne, 2-4 Route de Paris, 44300, Nantes, France
| | - Philippe Colls
- Department of Urology, Clinique Jules Verne, 2-4 Route de Paris, 44300, Nantes, France
| | - Valentine Guimas
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Emmanuel Rio
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Loïg Vaugier
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
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Rogé M, Perennec T, Guimas V, Hetet JF, Rio E, Vaugier L, Supiot S. Salvage radiotherapy after initial cryotherapy for localized prostate cancer: A systematic review of the literature. Crit Rev Oncol Hematol 2023; 192:104149. [PMID: 37813320 DOI: 10.1016/j.critrevonc.2023.104149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/31/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023] Open
Abstract
The treatment of local prostate cancer recurrence after cryotherapy is challenging since the optimal management is unknown. We collected the available evidence to date to better define the risk and benefit of salvage radiotherapy (SRT) after cryotherapy failure for localized prostate cancer. This review confirms the feasibility of SRT in terms of biochemical control and late toxicity rate. However, the absence of comparative trials or prospective studies, coupled with the heterogeneity of patients treated and the variations in treatments delivered across the analyzed studies, highlights the need for cautious consideration when opting for salvage radiotherapy. Therefore, we highly recommend the inclusion of patients in dedicated clinical trials to comprehensively assess the efficacy and safety of this approach.
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Affiliation(s)
- Maximilien Rogé
- Department of radiation oncology, Centre Henri Becquerel, 1 rue d'Amiens, 76000, Rouen, France.
| | - Tanguy Perennec
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
| | - Valentine Guimas
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
| | - Jean-François Hetet
- Department of Urology, Clinique Jules Verne, 2-4 route de Paris, 44300, Nantes, France
| | - Emmanuel Rio
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
| | - Loïg Vaugier
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
| | - Stéphane Supiot
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
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Deivasigamani S, Orabi H, El-Shafei A, Adams ES, Kotamarti S, Aminsharifi A, Davis L, Wu Y, J SJ, Polascik TJ. Intermediate-term oncological and functional outcomes of salvage cryotherapy for the management of prostate cancer recurrence after primary brachytherapy versus primary cryotherapy: A propensity score-matched analysis. Prostate 2023; 83:1373-1386. [PMID: 37469120 DOI: 10.1002/pros.24600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Salvage cryotherapy (SCT) is widely used to treat prostate cancer (PCa) recurrence after radiotherapy (RT). We studied the intermediate oncological and functional outcomes of patients who underwent SCT following cryotherapy (CRYO-SCT) recurrence and compare it to recurrence after brachytherapy (BT-SCT). METHODS An IRB-approved retrospective cohort study utilizing patient data from the Cryo On-Line Data Registry and the Duke PCa database between 1992 and 2016. Biochemical recurrence (BCR) using Phoenix criteria was the primary endpoint assessed at 2- and 5-years post-SCT. Secondary endpoints assessed functional outcomes including urinary continence, erectile function, and recto-urethral fistula. Association between treatment and biochemical progression-free survival was assessed using inverse probability weighted (IPTW) Cox proportional hazards regression. The differences in the secondary functional outcomes were assessed by Pearson's χ2 test or Fisher's exact test, corrected for IPTW. RESULTS A total of 194 patients met inclusion criteria. The BCR rate for BT-SCT and CRYO-SCT was 23 (20.4%) and 17 (21%) at 2 years and 30 (26.5%) and 22 (27.2%) at 5 years according to Phoenix criteria. There was no statistical difference in 2 years (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.5-1.7, p = 0.7) or 5-year BCR (HR: 0.86; 95% CI, 0.5-1.5, p = 0.6) between the groups. The functional outcomes like urinary continence (p = 0.4), erectile function (p = 0.1), and recto-urethral fistula (p = 0.3) were not statistically different. CONCLUSION CRYO-SCT appears to be well tolerated, with comparable oncological and functional outcomes to patients failing primary BT. The findings also demonstrated that SCT can render a significant number of patients biochemically free of disease after initial CRYO with minimal morbidity. SCT is a viable treatment option to salvage local PCa recurrence following either BT or cryoablation failure.
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Affiliation(s)
- Sriram Deivasigamani
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Hazem Orabi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Urology Department, Assiut University, Assiut, Egypt
| | - Ahmed El-Shafei
- Department of Urology, University of Florida Health, Jacksonville, Florida, USA
| | - Eric S Adams
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Srinath Kotamarti
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Ali Aminsharifi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Leah Davis
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Yuan Wu
- Duke Cancer Institute and Department of Statistics, Durham, North Carolina, USA
| | | | - Thomas J Polascik
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
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Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation. Adv Radiat Oncol 2022; 7:100849. [PMID: 35647408 PMCID: PMC9133399 DOI: 10.1016/j.adro.2021.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
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Atluri S, Mouzannar A, Venkatramani V, Parekh DJ, Nahar B. Focal therapy for localized prostate cancer - Current status. Indian J Urol 2022; 38:7-14. [PMID: 35136289 PMCID: PMC8796757 DOI: 10.4103/iju.iju_166_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/01/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Focal therapy (FT) has recently gained popularity for the treatment of localized prostate cancer (PCa). FT achieves cancer control by targeting the lesions or the regions of the cancer and avoids damage to the surrounding tissues thus minimizing side effects which are common to the radical treatment, such as urinary continence and sexual function, and bowel-related side effects. Various ablative methods are used to deliver energy to the cancerous tissue. We review the different modalities of treatment and the current state of FT for PCa.
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Affiliation(s)
- Shrikanth Atluri
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ali Mouzannar
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J. Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA,E-mail:
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Ennis RD, Vapiwala N. The Fallacy of the Consultation and Informed Consent Process in Radiation Oncology Through the Lens of Prostate Cancer. Int J Radiat Oncol Biol Phys 2021; 111:643-646. [PMID: 34560025 DOI: 10.1016/j.ijrobp.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ronald D Ennis
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - Neha Vapiwala
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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Jiang C, Godette K, Hall WA, Bennett JK, Rossi P, Cooper S, Jani AB, Patel PR. Early Comparative Toxicity Outcomes of Patients With Prostate Cancer Receiving Initial Cryotherapy and Radiotherapy Salvage. Clin Genitourin Cancer 2020; 19:267-270.e1. [PMID: 33191148 DOI: 10.1016/j.clgc.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Karen Godette
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Wauwatosa, WI
| | | | - Peter Rossi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Sherrie Cooper
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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Connor MJ, Gorin MA, Ahmed HU, Nigam R. Focal therapy for localized prostate cancer in the era of routine multi-parametric MRI. Prostate Cancer Prostatic Dis 2020; 23:232-243. [PMID: 32051551 DOI: 10.1038/s41391-020-0206-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prostate cancer focal therapy aims to minimize the side-effects of whole gland treatments, such as radical prostatectomy and radiotherapy without compromising oncological efficacy. However, concerns exist regarding the multifocal nature of prostate cancer and the lack of long-term oncological data for this form of treatment. In recent years, the routine adoption of multi-parametric magnetic resonance imaging (mpMRI) of the prostate has improved our ability to select candidates for focal therapy and to accurately deliver this form of prostate cancer treatment. METHODS We performed a review of the literature to provide a summary of the oncological and functional outcomes of men receiving primary prostate focal therapy. Furthermore, we discuss the impact of the routine implementation of mpMRI as part of the initial prostate cancer diagnostic pathway on the selection of candidates and delivery of focal therapy. Finally, we summarize knowledge gaps in the field and highlight active clinical trials in this arena. RESULTS Primary focal therapy involves the application of one of a number of energies that ablate tissue, such as cryotherapy and high intensity focused ultrasound (HIFU). Success is principally dependent on highly accurate patient selection and disease localization underpinned in large part by the routine integration of pre-biopsy mpMRI. Prospective medium-term follow-up data for primary HIFU and cryotherapy for men with intermediate-risk disease have shown acceptable cancer control with low risk of side effects and complications. Additional research is needed to clearly define an appropriate follow-up approach and to guide the management of in- and out-of-field recurrences. Multiple comparative trials with randomization against standard care are currently underway in men with intermediate- and high-risk prostate cancer. CONCLUSION The widespread adoption of prostate mpMRI has led to improved disease localization, enabling the performance of focal therapy as a viable treatment strategy for men with low volume intermediate-risk prostate cancer.
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Affiliation(s)
- M J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, W6 8RF, UK. .,Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK.
| | - M A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, W6 8RF, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
| | - R Nigam
- Royal Surrey NHS Foundation Trust, Guildford, Surrey, GU2 7XX, UK.,University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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Salvage Local Treatments After Focal Therapy for Prostate Cancer. Eur Urol Oncol 2019; 2:526-538. [DOI: 10.1016/j.euo.2019.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
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Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review. World J Urol 2019; 37:1517-1534. [DOI: 10.1007/s00345-019-02642-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 01/11/2019] [Indexed: 12/19/2022] Open
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Letter to the editor in response to Hopper et al, “Salvage image guided radiation therapy to the prostate after cryotherapy failure”. Adv Radiat Oncol 2018; 3:469. [PMID: 30197945 PMCID: PMC6127876 DOI: 10.1016/j.adro.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 11/23/2022] Open
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