Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of XXXX .

@entity1 @entity82 @entity263 @entity1486 @entity130
PURPOSE: High intensity focused ultrasound for the treatment of primary @entity263 is increasing in a subset of @entity1 seeking definitive treatment with reduced morbidity. We review outcomes in @entity1 undergoing salvage radical prostatectomy after failed whole gland high intensity focused ultrasound. MATERIALS AND METHODS: Prospective data were collected for @entity1 presenting with an increasing @entity1486 and biopsy proven @entity263 after high intensity focused ultrasound from 2007 to 2010 who underwent salvage open radical prostatectomy with a 22-month median followup, including @entity1486 , prostate volume, pathology results, continence and erectile function. RESULTS: Data for 15 @entity1 were available, including median age 64 years (IQR 55-69), Gleason score before high intensity focused ultrasound of 6 (8), Gleason score 7 (7), median cores positive 39% (IQR 17%-63%) and median @entity1486 7 ng/ml (IQR 5-8). Whole gland high intensity focused ultrasound achieved median nadir @entity1486 1.1 ng/ml (IQR 0.5-3.1). Biopsy after high intensity focused ultrasound demonstrated Gleason score 6 (in 3 @entity1 ), 7 (9) and 8/9 (3), and 42% (IQR 25%-50%) cores positive and a median time from high intensity focused ultrasound to radical prostatectomy of 22 months (IQR 7-26). Perioperative morbidity was limited to 1 transfusion in a @entity1 with a @entity130 . Pathologically extensive @entity82 was found with persistent @entity263 , as pT3 disease (in 9 of 14), Gleason scores 6 (2), 7 (9) and 8 of 9 (4), with focally positive margins in 3 of 11 (pT3a). Postoperative @entity1486 was unrecordable in 14 of 15 @entity1 with further treatment in 2. Postoperative continence (more than 12 months of followup) yielded no pad use in 6 of 10 @entity1 with universally poor erectile function. CONCLUSIONS: Radical prostatectomy as salvage is feasible for @entity1 in whom high intensity focused ultrasound failed, but with a higher morbidity than for primary surgery. Pathology results are alarming given the number of cases with extraprostatic extension yet early followup data suggest acceptable oncologic control. These results should be factored in when counseling @entity1 who wish to undergo primary high intensity focused ultrasound.
