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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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3/2019
vol. 11
 
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abstract:
Original paper

Whole-gland salvage treatment for recurrent prostate cancer after initial definitive radiotherapy: A case series of 125I brachytherapy and robot-assisted radical prostatectomy

Shinya Sutani
1
,
Atsunori Yorozu
1
,
Kazuhito Toya
1, 2
,
Toru Nishiyama
3
,
Choichiro Ozu
3
,
Yasuto Yagi
3
,
Ken Nakamura
3
,
Shiro Saito
3

  1. Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
  2. Department of Radiation Oncology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
  3. Department of Urology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
J Contemp Brachytherapy 2019; 11, 3: 201–206
DOI: https://doi.org/10.5114/jcb.2019.86163
Online publish date: 2019/06/23
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Purpose
To analyze outcomes following whole-gland salvage treatments applied to patients with pathology-proven, locally recurrent prostate cancer following primary definitive radiotherapy.

Material and methods
Eighteen consecutive patients who received whole-gland salvage treatments at our institution were retrospectively reviewed. All patients underwent transperineal template-guided mapping biopsy (TTMB) using the standard iodine-125 (125I) brachytherapy (BT) setup. Twelve patients received 125I BT, and six patients underwent robot-assisted laparoscopic prostatectomy (RARP). Prostate-specific antigen (PSA) failure was determined using the Phoenix definition (nadir + 2 ng/ml) following BT and a PSA level of > 0.2 ng/ml following RARP. Toxicities were graded according to CTCAE version 4.0.

Results
The median follow-up times were 71 and 11 months for the BT and RARP groups, respectively. In the BT group, the median dose to 90% of the prostate was 131 Gy. The median time to biochemical failure was 47 months, and the biochemical relapse-free survival (BRFS) rates were 56% (95% confidence interval [CI]: 33-94%) and 46% (95% CI: 25-88%) at 3 years and 5 years, respectively. Four patients (33%) developed grade 2 genitourinary (GU) toxicity, and two (17%) developed grade 3 GU toxicity. No patients developed grade ≥ 2 gastrointestinal (GI) toxicity. In the RARP group, three out of six patients (50%) had PSA failure, and four patients (67%) developed grade 2 GU toxicity. No patients developed grade 3 GU toxicity or grade ≥ 2 GI toxicity. On pre-salvage magnetic resonance imaging (MRI), no patients were suspected of having T3 or higher stage lesions. However, three patients (50%) had pT3a and two patients (33%) had pT3b (i.e., seminal vesicle invasion) stage lesions.

Conclusions
Whole-gland salvage BT is an effective treatment with an acceptable toxicity profile. The pathology findings from RARP imply that there is a room for improvement in diagnoses made by MRI in the pre-salvage setting.

keywords:

prostate cancer, salvage therapy, brachytherapy, prostatectomy

  
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