Photodynamic Therapy for Prostate Cancer Recurrence After Radiotherapy: A Phase I Study

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Oct 2002Photodynamic Therapy for Prostate Cancer Recurrence After Radiotherapy: A Phase I Study Timothy R. Nathan, Douglas E. Whitelaw, Stanley C. Chang, William R. Lees, Paul M. Ripley, Heather Payne, Linda Jones, M. Constance Parkinson, Mark Emberton, Alison R. Gillams, Anthony R. Mundy, and Stephen G. Bown Timothy R. NathanTimothy R. Nathan , Douglas E. WhitelawDouglas E. Whitelaw , Stanley C. ChangStanley C. Chang , William R. LeesWilliam R. Lees , Paul M. RipleyPaul M. Ripley , Heather PayneHeather Payne , Linda JonesLinda Jones , M. Constance ParkinsonM. Constance Parkinson , Mark EmbertonMark Emberton , Alison R. GillamsAlison R. Gillams , Anthony R. MundyAnthony R. Mundy , and Stephen G. BownStephen G. Bown View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64466-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Photodynamic therapy, using a photosensitizing drug activated by red light, can destroy localized areas of cancer with safe healing and without the cumulative toxicity associated with ionizing radiation. We used photodynamic therapy in a phase I–II study to treat patients with locally recurrent prostate cancer after radiotherapy. Materials and Methods: Patients with an increasing prostate specific antigen (PSA) and biopsy proven local recurrence after radiotherapy were offered photodynamic therapy. Three days after intravenous administration of the photosensitizer meso-tetrahydroxyphenyl chlorin, light was applied using optical fibers inserted percutaneously through perineal needles positioned in the prostate with imaging guidance. Patients were followed with PSA measurements, prostate biopsies, computerized tomography or magnetic resonance imaging and questionnaires on urinary and sexual function. Results: Photodynamic therapy was given to 14 men using high light doses in 13. Treatment was well tolerated. PSA decreased in 9 patients (to undetectable levels in 2) and 5 had no viable tumor on posttreatment biopsies. After photodynamic therapy, contrast enhanced computerized tomography or magnetic resonance imaging showed necrosis involving up to 91% of the prostate cross section. In 4 men stress incontinence developed (troublesome in 2 and mild in 2) which is slowly improving. Sexual potency was impaired in 4 of the 7 men able to have intercourse before photodynamic therapy, which did not improve. There were no rectal complications directly related to photodynamic therapy, but in 1 patient a urethrorectal fistula developed following an ill-advised rectal biopsy 1 month after therapy. Conclusions: Photodynamic therapy is a new option that could be suitable for organ confined prostate cancer recurrence after radiotherapy. With more precise light dosimetry, it may be possible to destroy essentially all glandular tissue within the prostate with few complications. These results suggest that photodynamic therapy merits further investigation. References 1 : Etiology, epidemiology, and prevention of carcinoma of the prostate. In: . Philadelphia: W. B. Saunders Co1998: 2489. chapt. 80. Google Scholar 2 : External beam radiation therapy does not offer long-term control of prostate cancer. Urol Clin North Am1996; 23: 617. Google Scholar 3 : Patient-reported complications and follow-up treatment after radical prostatectomy. The National Medicare Experience: 1988–1990 (updated June 1993). Urology1993; 42: 622. Google Scholar 4 : Outcomes of external-beam radiation therapy for prostate cancer: a study of Medicare beneficiaries in three surveillance, epidemiology, and end results areas. J Clin Oncol1996; 14: 2258. Google Scholar 5 : Treatment related sequelae following external beam radiation for prostate cancer: a review with an update in patients with stages T1 and T2 tumor. J Urol1994; 152: 1799. Link, Google Scholar 6 : Long-term survival among men with conservatively treated localized prostate cancer. JAMA1995; 274: 626. Google Scholar 7 : Interstitial and transurethral photodynamic therapy of the canine prostate using meso-tetra-(m-hydroxyphenyl) chlorin. Int J Cancer1996; 67: 555. Google Scholar 8 : Studies of tin ethyl etiopurpurin photodynamic therapy of the canine prostate. J Urol2001; 165: 1795. Link, Google Scholar 9 : Treatment options for localized recurrence of prostate cancer following radiation therapy. Urol Clin North Am1996; 23: 677. Google Scholar 10 : Short-term outcomes after cryosurgical ablation of the prostate in men with recurrent prostate carcinoma following radiation therapy. Urology1995; 46: 676. Google Scholar 11 : Salvage cryotherapy using an argon based system for locally recurrent prostate cancer after radiation therapy: the Columbia experience. J Urol2001; 166: 1333. Link, Google Scholar 12 : The contrasting mechanisms of colonic collagen damage between photodynamic therapy and thermal injury. Photochem Photobiol1987; 46: 795. Google Scholar 13 : Photodynamic therapy of localised prostatic cancer. Lancet1990; 336: 1139. Google Scholar 14 : Brachytherapy and organ preservation in the management of carcinoma of the prostate. Semin Radiat Oncol1993; 3: 240. Google Scholar From the National Medical Laser Center, Department of Surgery and the Institute of Urology, Royal Free and University College Medical School, London, the Departments of Imaging, Radiotherapy and Histopathology, University College London Hospitals, London, United Kingdom, and the Tzu-Chi College of Medicine, Hue-Lin, Taiwan© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byXiao Z, Dickey D, Owen R, Tulip J and Moore R (2018) Interstitial Photodynamic Therapy of the Canine Prostate Using Intra-Arterial Administration of Photosensitizer and Computerized Pulsed Light DeliveryJournal of Urology, VOL. 178, NO. 1, (308-313), Online publication date: 1-Jul-2007.Trachtenberg J, Bogaards A, Weersink R, Haider M, Evans A, McCluskey S, Scherz A, Gertner M, Yue C, Appu S, Aprikian A, Savard J, Wilson B and Elhilali M (2018) Vascular Targeted Photodynamic Therapy With Palladium-Bacteriopheophorbide Photosensitizer for Recurrent Prostate Cancer Following Definitive Radiation Therapy: Assessment of Safety and Treatment ResponseJournal of Urology, VOL. 178, NO. 5, (1974-1979), Online publication date: 1-Nov-2007.Eggener S, Scardino P, Carroll P, Zelefsky M, Sartor O, Hricak H, Wheeler T, Fine S, Trachtenberg J, Rubin M, Ohori M, Kuroiwa K, Rossignol M and Abenhaim L (2018) Focal Therapy for Localized Prostate Cancer: A Critical Appraisal of Rationale and ModalitiesJournal of Urology, VOL. 178, NO. 6, (2260-2267), Online publication date: 1-Dec-2007.Lane B, Stein D, Remzi F, Strong S, Fazio V and Angermeier K (2018) Management of Radiotherapy Induced Rectourethral FistulaJournal of Urology, VOL. 175, NO. 4, (1382-1388), Online publication date: 1-Apr-2006.Pinthus J, Bogaards A, Weersink R, Wilson B and Trachtenberg J (2018) Photodynamic Therapy for Urological Malignancies: Past to Current ApproachesJournal of Urology, VOL. 175, NO. 4, (1201-1207), Online publication date: 1-Apr-2006. Volume 168Issue 4 Part 1October 2002Page: 1427-1432 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsprostatic neoplasmsrecurrencephotochemotherapyradiotherapyMetricsAuthor Information Timothy R. Nathan More articles by this author Douglas E. Whitelaw More articles by this author Stanley C. Chang More articles by this author William R. Lees More articles by this author Paul M. Ripley More articles by this author Heather Payne More articles by this author Linda Jones More articles by this author M. Constance Parkinson More articles by this author Mark Emberton More articles by this author Alison R. Gillams More articles by this author Anthony R. Mundy More articles by this author Stephen G. Bown More articles by this author Expand All Advertisement PDF downloadLoading ...