Background: One-third of men may experience biochemical failure by 8 years following radical radiotherapy for prostate cancer. Focal salvage therapy (FST) may offer further curative treatment. Before FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected and characterised. Aim: The aim of this thesis was to evaluate novel diagnostic and staging techniques and outcomes of focal salvage treatments for radiorecurrent prostate cancer. Methods: Both retrospective and prospective data will be presented. A retrospective analysis was conducted to compare a) Bone scan with Choline PET/CT in the detection of distant metastases b) Accuracy of MRI-Targeted Biopsy (MRI-TB) with whole-gland template mapping biopsy (TPM) c) the outcomes of focal salvage HIFU (FS-HIFU). These retrospective analyses provided important inputs into the design and conduct of the prospective trial FORECAST - Focal RECurrent Assessment and Salvage Treatment. Key trial outcomes were a) detection rate of distant metastatic disease of Whole Body MRI compared to other staging scans b) detection rate of MRI for clinically significant prostate cancer and c) Short-term outcomes of focal salvage therapies. Outcomes: Within the retrospective analyses, there was poor concordance with bone scan and Choline PET/CT in the detection of metastatic disease (kappa value 0.024). MRI-TB had lower detection rates of clinically significant cancer compared with TPM biopsy; 77.9% vs. 85.7% (p=0.146). The b-DFS rate post FS-HIFU was 48% (95% CI 39–59) and composite end free survival was 40% (95% CI 31–50). In the prospective analyses, there was moderate agreement between WB-MRI and Choline PET/CT for bony metastatic disease (Kappa=0.411 (p < 0.0001)). MRI (PIRADS 4) had a high sensitivity, specificity, PPV and NPV for the detection of clinically significant cancer 90%, 81.3%, 85.7% and 86.7%. b-DFS rates post FS-HIFU and FS-cryotherapy was 73% (95% CI 51-100) and 67% (95% CI 30-100) at 12 months (p=0.95).
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:756357 |
| Date | January 2018 |
| Creators | Kanthabalan, Ana Abhiramy |
| Publisher | University College London (University of London) |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://discovery.ucl.ac.uk/10057034/ |
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