Multicentric evaluation of recurrence's management after brachytherapy for localized prostate cancer

The treatment of biochemical recurrence (BCR) after low-dose rate Brachytherapy (LDR-BT) for prostate cancer (PCa) includes local salvage therapy (LST) in case of localized recurrence, while systemic treatment is applied in metastatic cases. However, LST is rarely offered due to challenges in identifying the recurrence site. This study compared the recurrence's management after prostate LDR-BT among 2 French and 1 Canadian academic expert center, analyzing the detection and treatment of recurrences.

The RECCURIE project is a population-based retrospective cohort study including all patients presenting with BCR after treatment with LDR-BT for PCa in the 3 centers involved.

A total of 120 relapsing patients, pretreated with prostate LDR-BT in Paris, France (n=20); Reims, France (n=29); and Montreal, Canada (n=71), for low or intermediate-risk PCa, with a median follow-up of 82.8months, were included. When BCR occurs, the recurrence patterns differed between the centers, with exclusive biological recurrence, or clinically detected localized recurrence in 70 to 80% of patients while 20 to 30% had metastatic recurrence. A multiparametric Magnetic Resonance Imaging (mpMRI) was performed in only 11-55% of cases at recurrence, as well as prostate biopsy (PB) in 13-34% depending on the center. This suboptimal work-up of recurrence led to an underutilization of LST performed in 18% to 53% of the cases, depending on the realization of previous mpMRI and/or PB for recurrence staging.

The work-up performed at recurrence after LDR-BT varied between centers, with underutilized imaging and histology at the time of recurrence, leading to less frequent use of LST in favor of palliative ADT, even when a curative treatment was still possible.