PURPOSE: To evaluate the role of salvage prostate brachytherapy for locally recurrent prostate cancer after external beam radiation alone.
METHODS AND MATERIALS: Sixty-nine consecutive patients treated with salvage brachytherapy after a local failure were analyzed. All patients were found to have pathologic proven recurrent prostate cancer at least 2 years after initial therapy and no regional or distant disease on imaging studies. Pd-103 was used with a prescribed pD90 of 100 Gy. In total, 89.9% of patients received androgen suppression (AS) as part of their salvage therapy. Patients whose prostate-specific antigen >5.0 ng/mL while on AS were considered to have castration resistant prostate cancer (CRPC). Patients on AS >6 months before salvage brachytherapy were considered to have delayed therapy. Patients retreated within 5 years after their initial treatment were considered to have early failures.
RESULTS: Total median followup after salvage therapy was 5.0 years (0.6-13.7). From the date of salvage, 5-year biochemical control for low-risk patients was 85.6%, intermediate-risk patients 74.8%, and high-risk patients 66%. Five-year biochemical control was 73.8% for non-CRPC and 22% for CRPC cases (< 0.001). Including and excluding CRPC cases, early treatment after failure vs. delayed treatment was significantly better (p< 0.05). Chronic adverse events were seen in few patients, with genitourinary Grade 3 toxicity of 8.7% and no genitourinary Grade 4 or gastrointestinal Grade 3 or higher toxicities.
CONCLUSIONS: A subset of failures after definitive radiation is local in nature, and excellent control is possible with salvage brachytherapy.
Written by:
Vargas C, Swartz D, Vashi A, Blasser M, Kasraeian A, Cesaretti J, Kiley K, Koziol J, Terk M. Are you the author?
Florida Center for Prostate Care, Jacksonville, FL.
Reference: Brachytherapy. 2013 Nov 30. pii: S1538-4721(13)00379-6.
doi: 10.1016/j.brachy.2013.10.012
PubMed Abstract
PMID: 24295965
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