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Purpose: Locally recurrent prostate cancer after previous radiation therapy remains challenging. One of the curative options for these patients is salvage brachytherapy. There are no reports available on the use of a biodegradable rectal balloon implantation (RBI) in combination with brachytherapy in patients with recurrent prostate cancer after previous radiotherapy.Case presentation: Here, we report on a patient with a local recurrence at five years after previous low-dose-rate brachytherapy with a prescribed dose of 145 Gray (Gy) for a low-risk prostate adenocarcinoma. The patient experienced grade 3 rectal toxicity, which was resolved at the time of local recurrence. He was treated with focal high-doserate (HDR) brachytherapy of 2 fr. × 13 Gy after RBI implantation. Four years post-salvage treatment, there was no evidence of biochemical recurrence according Phoenix definition, and no gastro-intestinal or genitourinary toxicity.Conclusions: This case describes the use of RBI implantation in combination with a focal salvage HDR in a patient with recurrent disease, with significant initial grade 3 rectal toxicity after previous irradiation. The use of a biodegradable RBI proved to be a promising solution for such a patient; however, this method needs to be further investigated.

difference we found was on the knowledge-test, with a higher score in patients in the post-implementation arm (7.4 out of 11 points vs 6.1 out of 11).Conclusions: Use of the PtDA did result in better knowledge, suggesting a better informed choice. We found no differences in decisional conflict and on perception of SDM, between the pre-and post-implementation arms. The relatively low level of decisional conflict in the pre-intervention arm might be explained by increased awareness among the professionals for SDM already in the pretest phase of the trial. Implementation of only a PtDA might be insufficient to achieve improvement in experienced SDM.No conflict of interest.