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Early detection and treatment of local recurrence increases the possibility of cure, in addition to preventing the use of unnecessary hormonal therapy. At present, radiation therapy is widely used as a salvage therapy after RPx.82�C85 However, this therapy is time-consuming and might not be tolerated https://en.wikipedia.org/wiki/Crotamiton by some patients with poor performance status. Two current reports describe the use of salvage HIFU after recurrence RPx (Table?9).43,44 Hayashi et?al. reported the use of HIFU in four patients with biochemical failure after RPx.43 However, in this study, tumor masses were not identified by TRUS imaging, and HIFU treatments in the vesico-urethral anastomotic lesion were carried out based on PSA elevations of more than 0.2?ng/mL after RPx. The median PSA levels before and after HIFU were 0.555?ng/mL and 0.054?ng/mL, respectively. Murota et?al. reported on four cases of patients with biopsy-proven local recurrence of prostrate carcinoma in the vesico-urethral anastomotic lesion after RPx.44 In all the patients on whom biopsies were carried out, HIFU was shown to cause coagulation necrosis and fibrosis at the anastomotic lesion safely and within a short treatment time. Because the HIFU procedure takes just 10�C20?min under local anesthesia, patients are able to go home in a few hours. The minimally invasive nature of HIFU provides a broader opportunity for local treatment, even in patients who are not candidates for salvage radiation therapy. The European Association http://www.selleckchem.com/products/rxdx-106-cep-40783.html of Urology guidelines defines relapse after local therapy as PSA values >0.2?ng/mL after radical prostatectomy and >2?ng/mL above the nadir after radiation therapy. Therapy for PSA relapse after radical prostatectomy includes salvage radiation therapy for PSA levels http://www.selleckchem.com/products/CP-673451.html be needed to further study the effectiveness of HIFU and to evaluate any possible adverse effects. The currently accepted curative treatment approaches for localized prostate cancer depend on patient and tumor factors, and consist of surgery, radiotherapy and brachytherapy. Other approaches include hormonal therapy and active surveillance. Although no randomized controlled trials are underway or have been carried out to compare these options, each has evolved as a standard of care based on extended long-term patient follow up of greater than 7�C10?years in well-designed prospective clinical studies. The decision to use HIFU rather than surgery is often made on the basis of patient factors, such as patient preference, age, comorbid conditions and the availability of surgical expertise.