Brachytherapy for prostate cancer: follow-up and management of treatment failures.
The use of prostate brachytherapy for the treatment of early-stage, low-grade, low-volume carcinoma of the prostate continues to rise. Given the prolonged natural history of these early lesions, treatment failures may take many years or even a decade or more before becoming clinically evident. It is therefore likely that as the brachytherapy data mature, clinicians will be asked to help manage a potentially large cohort of men who have failed this local therapy--a scenario that will provide a number of unique challenges for the treatment of the disease and the management of the lower urinary tract. This article offers a contemporary review and suggestions with regard to the follow-up of patients who have undergone prostate brachytherapy, including low-dose rate permanent implants and high-dose rate temporary implants for the management of localized prostate cancer. In addition, current controversies in defining biochemical failure following radioactive implantation--including important data regarding the "prostate-specific antigen bounce" phenomenon--are discussed. Finally, a comprehensive review of the management of local recurrence following brachytherapy is offered.
Horwitz
Eric M
EM
Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
Uzzo
Robert G
RG
Miller
Nicole
N
Theodorescu
Dan
D
D001706:Biopsy; D001918:Brachytherapy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D017211:Treatment Failure
D017430:Prostate-Specific Antigen