Salvage Brachytherapy for Castration-Resistant and External Beam Radiotherapy-Resistant Local Recurrence 17 Years after Radical Prostatectomy

Abstract

A 47-year-old Japanese man was diagnosed with prostate cancer in February 1995 (Initial PSA 77.2 ng/mL, GS3 + 4, cT3N0M0). He underwent radical prostatectomy after androgen deprivation therapy (ADT) in June 1995. Nine years after operation, he was diagnosed with local recurrence of prostate cancer and he received postoperative external beam radiation therapy (EBRT) (70 Gy). By May 2008, the PSA dropped to 0.33 ng/mL, and a CT scan showed that the mass had disappeared. On April 2012, the PSA once again rose to 3.1 ng/mL. CT scan and MRI revealed a mass in the prostatic bed. We diagnosed local recurrence of prostate cancer. We underwent salvage low-dose brachytherapy after obtaining informed consent. The prescribed dose of the salvage brachytherapy was 145 Gy to control the tumor considering the hormone resistant prostatic cancer and high-risk feature. PSA level rapidly decreased to 0.66 ng/mL by 6 months after seed implantation. No adverse events were seen during the follow-up period.

Salvage Stereotactic Reirradiation for Local Recurrence in the Prostatic Bed After Prostatectomy: A Retrospective Multicenter Study

“…Another case series of 15 patients reported 60% BCR after cryoablation as a salvage treatment in the prostatic bed without previous EBRT [26]. Brachytherapy has also been less reviewed than SBRT in reirradiation of the prostatic bed [27,28]. Salvage surgery after RP for recurrence in the prostatic bed was reported in a recent retrospective series of 40 patients, with 83% of them receiving adjuvant or salvage EBRT.…”

Salvage low-dose-rate brachytherapy for local recurrences after prostatectomy and adjuvant or salvage external beam irradiation: Feasibility study on five patients and literature review

“…For nonoperated patients, brachytherapy has already been widely evaluated as an option for salvage therapy after external radiation therapy with acceptable toxicity (20e23) and a Phase II prospective study demonstrated that LDR brachytherapy after external radiation demonstrated acceptable late gastrointestinal and genitourinary adverse events (24). However, data are very scarce for salvage brachytherapy (S-BT) for local recurrences within the prostate (or SV) bed after RP with or without adjuvant or salvage EBRT, with only eight published experiences (10e13,25e28), including 2 case reports (13,27) and six series. Kumar et al publication (26) is an update of the series initially published by Traud et al (29) and therefore is not included in the table summarizing the literature review of S-BT (Table 3).…”

Nonmetastatic castration‐resistant prostate cancer treated with salvage focal brachytherapy after external beam radiotherapy

“…Botticella et al examined the curative role of 78 Gy EBRT on the prostate in a retrospective study including 42 patients with nonmetastatic CRPC and reported a 60% survival rate without distant metastasis and a 65% cancer‐specific survival rate at 5 years 8 . Hosogoe et al reported a case in which salvage whole‐gland brachytherapy (145 Gy) was performed for EBRT‐resistant local recurrence of CRPC, and PSA levels rapidly decreased within 6 months 9 …”