Combined prostate brachytherapy and short-term androgen deprivation therapy as salvage therapy for locally recurrent prostate cancer after external beam irradiation.
OBJECTIVE
We describe the treatment outcome in 17 patients who received combined salvage brachytherapy and short-term androgen deprivation therapy for local prostate cancer relapse after prior external beam irradiation.


METHODS
Median patient age was 68 years. Local relapse after external beam irradiation was confirmed by biopsy. Median prostate specific antigen at local relapse was 4.7 ng/ml. Five of the 17 patients were enrolled in a protocol combining androgen deprivation therapy with brachytherapy and the remaining men were treated off protocol. All patients received neoadjuvant androgen deprivation therapy for a median of 3 months, followed by ultrasound guided brachytherapy using 125I in 9 and 103Pd seeds in 8. Five patients also received adjuvant leuprolide for a median of 6 months. Biochemical failure was defined using the American Society for Therapeutic Radiology and Oncology definition. Toxicity was graded with a modified Radiation Therapy Oncology Group scale.


RESULTS
Median followup was 44 months. The actuarial 4-year biochemical control rate was 75%. Three patients died of intercurrent diseases. No prostate cancer mortality or local failure had occurred at last followup. One patient had bone metastasis. No clinical or treatment factor was associated with biochemical control. Grade 3 and 4 genitourinary toxicity developed in 7 (41%) and 1 patients (6%), respectively. Grade 2 and 3 gastrointestinal toxicity occurred in 5 (29%) and 1 patients (6%), respectively.


CONCLUSIONS
Our series suggests that salvage brachytherapy and short-term androgen deprivation therapy can achieve biochemical control in select patients with local relapse after prior external beam irradiation. The major side effects are urinary complications, including grade 3 and 4 complications in 41% and 6% of cases, respectively.
Wong
William W
WW
Departments of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA. wong.william@mayo.edu
Buskirk
Steven J
SJ
Schild
Steven E
SE
Prussak
Karin A
KA
Davis
Brian J
BJ
D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001918:Brachytherapy; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D016879:Salvage Therapy; D013997:Time Factors
D018931:Antineoplastic Agents, Hormonal; D016729:Leuprolide