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Salvage Brachytherapy for Biochemically Recurrent Prostate Cancer following Primary Brachytherapy
John M Lacy1, William A Wilson2, Raevti Bole3
1Department of Urology, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
Prostate Cancer
|April 20, 2016
Summary
Salvage brachytherapy can be effective for recurrent prostate cancer, achieving about 50% biochemical recurrence-free survival. While side effects may increase after a second procedure, outcomes suggest potential benefits, especially for low-risk patients.
Area of Science:
- Oncology
- Urology
- Radiation Oncology
Background:
- Prostate brachytherapy is a common treatment for localized prostate cancer.
- Biochemical recurrence after initial brachytherapy necessitates further treatment strategies.
- Salvage therapy aims to re-treat recurrent disease while minimizing morbidity.
Purpose of the Study:
- To evaluate the efficacy and outcomes of salvage brachytherapy in patients with biochemical recurrence after initial brachytherapy.
- To assess the oncologic control and side-effect profile of repeat brachytherapy procedures.
- To identify patient subgroups that may benefit most from salvage brachytherapy.
Main Methods:
- Retrospective review of 21 patients treated with salvage brachytherapy between 2001 and 2012.
- Inclusion criteria: biochemical failure after prior brachytherapy, no evidence of metastases.
- Computed tomography (CT) scans used to identify underseeded areas for reimplantation.
Main Results:
- 52.4% (11/21) of patients achieved freedom from biochemical recurrence at a median follow-up of 61 months.
- Low-risk patients showed a trend towards decreased freedom from biochemical recurrence (p = 0.12).
- International Prostate Symptom Scores (IPSS) temporarily increased but returned to baseline by 18 months; side effects were higher than after the first procedure.
Conclusions:
- Salvage brachytherapy is a feasible option for managing biochemical recurrence after initial prostate brachytherapy.
- Approximately 50% oncologic control can be achieved, with potential for better outcomes in low-risk patients.
- While feasible, salvage brachytherapy may be associated with an increased side-effect profile compared to the primary procedure.
