Salvage Ablation for Locally Recurrent Prostate Cancer

Derek J. Lomas; David A. Woodrum; Lance A. Mynderse

Disclosures

Curr Opin Urol. 2021;31(3):188-193. 

In This Article

Adverse Effects

Despite being one of the least invasive salvage ablation options, HIFU can have significant adverse effects particularly bladder outlet obstruction and urinary retention.

Valle et al. reported rates of severe (grade 3 or higher) genitourinary and gastrointestinal toxicity of 23 and 1.6%, respectively.[3] Ingrosso et al. reported a pooled prevalence of adverse effects including incontinence (28%), obstruction (26%), urethral stricture (9%), recto-urethral fistula (2%), perineal pain (8%), and erectile dysfunction (35%).[15] Devos et al. found that HIFU had a significantly lower rate of incontinence requiring pads compared to prostatectomy (22.2% vs. 56.0%) at 12 months. Grade 3 complications with HIFU included rectal fistula (3.1%), bladder neck contracture (18.8%), and urinary retention (34.4%).[21] Like with cryotherapy, salvage partial gland treatment with HIFU has been explored. Compared to whole gland HIFU, hemiablation resulted in decreased rates of incontinence (14% vs. 54%), bladder outlet obstruction (13% vs. 46%), and grade 3 complications (13% vs. 63%).[22]

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