Towards focal salvage therapy for prostate cancer recurrences

The diagnosis and treatment of patients with recurrent prostate cancer after radiotherapy is problematic in current clinical practice. Diagnostic possibilities for the detection of recurrences are limited. Further, conventional salvage techniques for the treatment of recurrences are known to have low chances of success and high toxicity rates. The various studies published in this thesis all serve the main research objective of improving the diagnosis and treatment of prostate cancer recurrences. It was investigated whether dynamic contrast enhanced (DCE-)MRI could serve as a diagnostic aid in the early detection of prostate cancer recurrences. Further, we investigated the theoretical possibility of a new salvage treatment strategy, focal salvage, and tested the feasibility of this treatment in clinical practice. The explorative studies described in this thesis are the first steps towards a new approach in the diagnosis and treatment of patient with recurrent prostate cancer after radiotherapy. We demonstrated that focal salvage 125-I brachytherapy can be associated with less treatment-related toxicity compared to conventional salvage. Further, we showed that DCE-MRI can be used to differentiate between patients with and without recurrent prostate cancer. Last, we also presented the first successful steps in MRI-guided robotic prostate interventions using the UMCU robot. These three major branches within the presented research will be continued to be investigated in the University Medical Center Utrecht in the future. More experience and further development will lead to better evidence to support the clinical implementation of these techniques and for better perspectives for prostate cancer patients.