HDR monotherapy for man with radiotherapy contraindications and prostate cancer

There is debate about the optimal management of high risk localized prostate cancer. Initial options include surgery or radiation combined with androgen deprivation therapy. We describe a case of a patient with contraindications to radiotherapy who was managed with high dose rate (HDR) brachytherapy as his sole treatment. A medically operable patient presented with a T2c N0 M0 Gleason 9 adenocarcinoma with an initial PSA of 19.9 ng/mL. Previously, he had severe ulcerative colitis managed with pancolectomy and a neorectum fashioned from ileum anastomosed behind his prostate. After a negative extended lymph node dissection, a HDR brachytherapy implant of 35 Gy in 5 fractions over 3 days was delivered. No androgen deprivation therapy was used. The treatment was extremely well tolerated in the short and long term with no significant bowel or bladder side effects observed in follow up. After 7 years, his PSA was 0.04 ng/mL. The excellent long-term biochemical control and minimal radiation toxicity observed in this patient suggests that HDR monotherapy may be a safe and effective alternative for high risk prostate cancer patients in whom EBRT is contraindicated.