title: Permanent seed brachytherapy for locally recurrent prostate cancer after radical prostatectomy: a case report and review of the literature.
abstract: OBJECTIVE
  To describe the management of a patient with locally recurrent prostate cancer in the prostate bed, 10 years after a radical prostatectomy.
  
  
  METHODS
  A 71-year-old man had a radical prostatectomy for a Gleason 7 clinical T2a carcinoma of the prostate in 2000. Final pathologic stage was pT3a pN0. Postoperatively his prostate-specific antigen was undetectable, but by 2008 it was 1.0ng/mL and in 2011 it reached to 1.43ng/mL. He was referred for consideration of salvage radiotherapy. Staging workup was negative but transrectal ultrasound revealed a 15cc recurrence in the prostate bed. A combination of external beam radiation therapy (4600/23/4.5 weeks to the pelvis) and a brachytherapy boost (115Gy) was selected for definitive management. Androgen ablation was not used.
  
  
  RESULTS
  The treatment was well tolerated. The brachytherapy boost was planned in a similar fashion to a de novo implant for an intact prostate. The postimplant dosimetry was evaluated using magnetic resonance imaging-computed tomography (MR-CT) fusion and appeared satisfactory. Acute toxicity was minimal. Six months after brachytherapy, the prostate-specific antigen had fallen from 1.43 to 0.05ng/mL.
  
  
  CONCLUSIONS
  Dose escalation with combined external beam and brachytherapy may be feasible if recurrent disease can be visualized using transrectal ultrasound and encompassed in an implanted volume. Although longer followup and a larger series of patients are required to demonstrate safety and efficacy, consideration should be given this approach.
authors: Department of Radiation Oncology, British Columbia Cancer Agency, Center for the Southern Interior, University of British Columbia, Kelowna, British Columbia, Canada.
authors: Miren
authors: M
authors: Gaztañaga
authors: Juanita Mary
authors: JM
authors: Crook
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D009364:Neoplasm Recurrence, Local; D017430:Prostate-Specific Antigen; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen