Salvage brachytherapy after definitive EBRT

The most common method for salvage therapy in men with recurrent, localized prostate cancer after first-line external beam radiation therapy (EBRT) is surgery. However, a newly published study reports one group’s experience with salvage permanent perineal radioactive-seed implantation (SPPI) as a possible therapeutic option for recurrent prostate adenocarcinoma after EBRT.

Aaronson et al. conducted a retrospective analysis of data from a total of 37 patients who had SPPI for localized recurrent prostate adenocarcinoma between 1996 and 2007 after primary treatment with EBRT. Patients who had other forms of primary treatment or who had no follow-up were excluded from the data set. Primary outcomes were time to biochemical relapse-free survival, using the Phoenix definition of a PSA nadir + 2 ng/ml, and cancer-specific survival.

The authors report their results as follows:

  • Of the 37 patients treated with SPPI, only 24 met the inclusion and exclusion criteria.
  • At the time of salvage therapy, the median time to diagnosis of local recurrence was 49 months, the median PSA level was 3.36 ng/ml, the median PSA doubling time was 20 months, and all patients were clinically re-staged as ≤ T2 with negative transrectal ultrasonography and/or magnetic resonance spectroscopy.
  • The original Gleason scores were ≤ 6 in nine patients, 7 in eight and ≥8 in three. (Gleason scores were not available for two patients).
  • The median follow-up after SPPI was 30 months.
  • The cancer-free survival rate was 96 percent (one death) and biochemical relapse-free survival rate was 88% (three patients relapsed).
  • The PSA level was higher than the levels before SPPI at 3 months in all three failures, but lower in all 21 patients considered relapse-free.
  • Complications included one urethral stricture, one grade 3 rectal haemorrhage, and five grade 2 gross haematuria that resolved with conservative management.

The authors conclude that, at 30 months of follow-up, SPPI appears to provide excellent prostate cancer control with an acceptable rate of complications for patients with local recurrence of their prostate cancer after EBRT. They note that extended follow-up will be required to determine the long-term durability and safety of SPPI.

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