Salvage partial brachytherapy for prostate cancer recurrence after primary brachytherapy

• Published in: International journal of urology 2014-06, Vol.21 (6), p.572-577
• Main Authors: Sasaki, Hiroshi, Kido, Masahito, Miki, Kenta, Kuruma, Hidetoshi, Takahashi, Hiroyuki, Aoki, Manabu, Egawa, Shin
• Format: Article
• Language: English
• Subjects: Aged; Brachytherapy - methods; Humans; local recurrence; Male; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - radiotherapy; prostate cancer; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; salvage partial brachytherapy; Salvage Therapy; Treatment Failure
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.12373

Objectives To characterize local recurrence of prostate cancer and to assess the effect of salvage partial brachytherapy after primary 125‐iodine low‐dose rate brachytherapy with or without external beam radiotherapy in Japanese men. Methods Between 2003 and 2010, a total of 616 consecutive patients underwent low‐dose rate brachytherapy‐based therapy for clinically localized prostate cancer at Jikei University Hospital in Tokyo, Japan. Biochemical recurrence occurred in 45 (7.3%) patients at a median of 30 months (range 11–93 months). A total of 20 patients subsequently underwent transperineal template prostatic biopsy; of those, eight had positive cores at the base of the prostate or at the seminal vesicles. These eight patients had underdosed areas identified at initial low‐dose rate brachytherapy corresponding to the positive biopsy sites. All were confirmed to have only localized recurrence, and seven underwent salvage partial low‐dose rate brachytherapy. Results Median prostate‐specific antigen nadir level in the eight patients with biopsy‐proven local recurrence after initial low‐dose rate brachytherapy was 0.75 ng/mL (range 0.39–2.06). The seven retreated patients tolerated the salvage partial low‐dose rate brachytherapy well, and showed a decrease in prostate‐specific antigen level at follow up. Two patients later developed biochemical and clinical progression at 11 and 13 months, respectively. Prostate‐specific antigen level continued to be low in the remaining five patients. No significant genitourinary or gastrointestinal toxicity was encountered. Conclusions Salvage partial low‐dose rate brachytherapy for biopsy‐proven localized prostate cancer recurrence appears rational, technically feasible and safe. Optimal patient selection is of utmost importance for long‐term success. Larger studies with longer follow up are warranted.