radiofrequency interstitial tumor ablation (RITA) for the focal treatment of patients with local prostate cancer recurrence.

[Tommyj2]

Published in 2005... wondering if any here have had any experience with this technique which appears to involve the insertion of needles Transrectally and ablating areas of cancer with heat..... The results in this study were quite good but I don't hear it referenced in our group ( likely because most of us are beyond the point of local cancer recurrence).... I'm meeting with an MO soon and depending on test recommendations and results could find that I would be a potential candidate.... My ever hopeful search for a way around standard ADT!!

[Tall_Allen]

Was this about salvage ablation after prostatectomy or after primary radiotherapy, and how was the recurrence site detected in that study? In general, RF ablation hasn't received as much attention as newer techniques like HIFU, IRE, FLA or PDT.

[Tommyj2 in reply to Tall_Allen]

Have to relocate the article... but recollection is that sites were located via 12 core biopsy. This done post failed initial RT... I ask BECAUSE I have heard so little about it..... I'll look again to see if the abstract mentions image guidance or other methods used to locate sites to be treated... two things of which I AM sure is that 12 core biopsy done and RT had failed to be curative....

[Tommyj2 in reply to Tall_Allen]

Below is everything _ I_ know about this method.... it was a pilot study with a small sample and does not make entirely clear how areas to be treated were located beyond treating where the biopsy cores were positive under Ultrasound guidance. No long term follow up mentioned ( median 20 months but no specifics) Prospective study with seemingly positive results on low and intermediate risk subjects.... only a modest amount of information on specifics..... hence my question...

==============

Abstract

BACKGROUND

To prospectively evaluate the feasibility, safety, morbidity, and preliminary efficacy of radiofrequency interstitial tumor ablation (RITA) for the focal treatment of patients with local prostate cancer recurrence.

METHODS

Eleven patients with biopsy‐proven, hormone‐naïve, clinically localized prostate cancer were enrolled in a prospective phase I/II trial. Eight patients had failed prior radiation therapy and three were not candidates for curative primary therapy (median Gleason score 7 and 6, respectively). Median follow‐up was 20 months. All patients were treated with RITA in an office setting, under intravenous sedation and were discharged after the procedure. Radiofrequency energy was applied via needles placed transperineally under transrectal ultrasound guidance.

RESULTS

The placement of 1/4 lesions was aborted in two patients due to increasing rectal temperature. Complications included transient macrohematuria (19%), bladder spasms (9%), and dysuria (9%). Serum PSA levels decreased after RITA >50% in 90% of patients, > 70% in 72% of patients, and > 80% in 46% of patients. The mean PSA doubling time after RITA was slower than that before RITA (37 ± 22 months vs. 14 ± 13 months, P = 0.008). At 12 months after RITA, 50% of patients with sufficient follow‐up had no residual cancer on repeat systematic 12‐core biopsy cores and 67% were cancer‐free in biopsy cores sampled from the RITA‐treated areas.

CONCLUSIONS

RITA treatment is a minimal invasive, rapid, user‐friendly, office‐based procedure that is well tolerated. Focal ablation with RITA results in effective local disease control in patients with non‐metastatic prostate cancer recurrence. Larger, prospective, multicenter clinical studies are needed to confirm these findings. Prostate. © 2005 Wiley‐Liss, Inc.

[Tall_Allen in reply to Tommyj2]

I didn't include RF because there is so little data, but the best salvage after radiation failure, in terms of cancer control and side effects seems to be focal salvage brachytherapy. Whole gland salvage SBRT looks pretty good too. Follow-up is limited on all studies so far.

pcnrv.blogspot.com/2017/09/...

[Tommyj2 in reply to Tall_Allen]

Thank you Allen... seems there is no escaping this sinking ship without a high probability of incurring SOME kind of injury... pick your poison and hope you chose correctly : )

See what the MO has to say in a couple of weeks and hope she is well schooled in modern salvage techniques.... IF I turn out to have discerably localized recurrence.

[Tall_Allen in reply to Tommyj2]

Why would an MO know anything about it? You have to meet with experts in those techniques, not an MO.

[Tommyj2 in reply to Tall_Allen]

Wishful thinking on my part....

Relying on this group and Internet searches for current infomation on who is doing. Was hoping that MO would have a bead on what research is going on in my area and be able to make helpful suggestions..... Perhaps I am under a misapprehension as to the role of a medical oncologist??

[Tall_Allen in reply to Tommyj2]

Medical oncologists for prostate cancer use medicines to manage prostate cancer -- they don't practice or follow patients who are seeking a cure. Where are you located?

[Tommyj2 in reply to Tall_Allen]

I am in Southeastern NY State... approx 50 miles outside of NYC

[Tall_Allen in reply to Tommyj2]

Try to meet with Michael Zelefsky at MSK about focal salvage brachytherapy. Jonathan Coleman at MSK is knowledgeable about most kinds of focal ablation. Maybe you can meet with both on the same day. NIH (Washington DC) is running a free clinical trial of salvage SBRT after RT failure.

clinicaltrials.gov/ct2/show...

[Tommyj2 in reply to Tall_Allen]

Great information.... thanks for the names. I'm thinking I will need to press this MO ( if she doesn't bring it up herself) to prescribe some form of a PET/CT to find out if I am even a candidate for any form of salvage therapy... my numbers suggest the possibility that I could still be localized but as you pointed out in a previous post I could also find out that I have enough micrometastases that sourcing the origin could be impossible.....

[Tall_Allen in reply to Tommyj2]

If you are at nadir+2, you will qualify for Axumin PET. I think Zelefsky will recommend an mpMRI, with biopsy, to identify the site if a local recurrence - at least that's what he used in this study:

pcnrv.blogspot.com/2016/08/...

auajournals.org/article/S00...

[Hidden]

You might want to research HIFU. That is the path I took. After prior TURP surgery I was ruled out for conventional RP type surgery. I was steered toward radiation but I had heard about too many side effects of external beam radiation and was told that brachytherapy had "gone out of favor". Guess it wasn't in that urologist or his radiation partners' bag of tricks.

[Tommyj2 in reply to Hidden]

Thank you for your response. Was the treatment successful for you?? I'm guessing not entirely as you are still active in this group but this could be wrong.... I've heard a lot about HIFU but didn't know if it was being offered in the US.

[Hidden in reply to Tommyj2]

Successful so far. I remain on this site to continue my education. Recurrence is always a possibility.

[Tommyj2 in reply to Hidden]

Was the TURP for initial Tx of Prostate Ca?? I didn't think anybody did that anymore?.... Presuming the HIFU was for salvage? How many years out are you?? Where did you have it done ( didn't think it was available in the United States? or at least not covered by insurance).... any important post Tx symptoms??

[Hidden in reply to Tommyj2]

No the TURP was 10 years prior to cancer diagnosis -- for urination difficulties due to BPH. As it turns out TURP is a good thing when considering HIFU. Some people have TURP prior to HIFU. I had the HIFU done by Dr Lazar from Santa Rosa, CA. The outpatient operating facility was in SF. I am 2 1/2 years out and no quality of life issues. I am off ADT and PSA has risen from undetectable to 0.3 where it has stayed for the last two measurements, 4 months apart. I paid out of pocket in 2016 but I hear that Medicare and some insurance programs will cover some of the cost.

[Tommyj2 in reply to Hidden]

You were on ADT PRIOR to the procedure?? Presumably to shrink the tumor?? Weaken the Pca cells?... Glad your results have been positive so far..... Hope the trend continues.....

[Hidden in reply to Tommyj2]

I was given a six month eligard shot in preparation for radiation. I changed my mind and went with HIFU instead, about 8 weeks after the shot. It did shrink the prostate from 34 to 27.

[Currumpaw]

Hey Tommyj2!

I have been following FLA or, Focal Laser Ablation. The doctors practicing it in the US are getting better and their patients are having very good results. They are doing FLA using a 3.0 MRI. The procedure is done real time, in bore. Side effects are minimal.

HIFU is supposed to be advancing. Maybe HIFU is also now using the 3.0 MRI in real time rather than as it was performed recently by using a 1.5 MRI taken prior to the ablation treatment, which was then fused to an ultrasound screen.

Proton therapy is another option.

You might want to look into these other treatments.

Currumpaw

[Tommyj2 in reply to Currumpaw]

Thank you for the suggestions... I don't yet actually know if I am a candidate for any of these salvage techniques but expect to know in a couple of months.... ADT will destroy what I have left of my " outdoor" life in concert with my advancing arthritis leaving me few hobbies or interests that have a social component.... REALLY hoping to find away around it...... This group is phenomenal for it's cumulative knowledge and breadth of experience.... are you looking into salvage methods for yourself or just following FLA as something you MIGHT have done at another time??

BOb

[Tommyj2 in reply to Currumpaw]

Not familiar with " in bore"... are you aware who is doing FLA in the United States.. I like the idea of MRI guidance in real time... working from a " picture" and hoping for the best has always disturbed me : )

[Currumpaw]

If I were to choose FLA, Dr. Karamanian in Houston would be my first choice as a doc. I've been following FLA patients and the results they have.