title: Salvage brachytherapy for recurrent prostate cancer.
abstract: OBJECTIVE
  To evaluate the role of salvage prostate brachytherapy for locally recurrent prostate cancer after external beam radiation alone.
  
  
  METHODS
  Sixty-nine consecutive patients treated with salvage brachytherapy after a local failure were analyzed. All patients were found to have pathologic proven recurrent prostate cancer at least 2 years after initial therapy and no regional or distant disease on imaging studies. Pd-103 was used with a prescribed pD90 of 100 Gy. In total, 89.9% of patients received androgen suppression (AS) as part of their salvage therapy. Patients whose prostate-specific antigen >5.0 ng/mL while on AS were considered to have castration resistant prostate cancer (CRPC). Patients on AS >6 months before salvage brachytherapy were considered to have delayed therapy. Patients retreated within 5 years after their initial treatment were considered to have early failures.
  
  
  RESULTS
  Total median followup after salvage therapy was 5.0 years (0.6-13.7). From the date of salvage, 5-year biochemical control for low-risk patients was 85.6%, intermediate-risk patients 74.8%, and high-risk patients 66%. Five-year biochemical control was 73.8% for non-CRPC and 22% for CRPC cases (<0.001). Including and excluding CRPC cases, early treatment after failure vs. delayed treatment was significantly better (p<0.05). Chronic adverse events were seen in few patients, with genitourinary Grade 3 toxicity of 8.7% and no genitourinary Grade 4 or gastrointestinal Grade 3 or higher toxicities.
  
  
  CONCLUSIONS
  A subset of failures after definitive radiation is local in nature, and excellent control is possible with salvage brachytherapy.
authors.affiliation: Florida Center for Prostate Care, Jacksonville, FL. Electronic address: cvargas@frogdocs.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vargas
authors.affiliation: McIver Urological Clinic, Jacksonville, FL.
authors.forename: Douglas
authors.initials: D
authors.lastname: Swartz
authors.affiliation: McIver Urological Clinic, Jacksonville, FL.
authors.forename: Apoorva
authors.initials: A
authors.lastname: Vashi
authors.affiliation: Urology Associates of Northeast Florida, Orange Park, FL.
authors.forename: Marc
authors.initials: M
authors.lastname: Blasser
authors.affiliation: Kasraeian Urology, Jacksonville, FL.
authors.forename: Ali
authors.initials: A
authors.lastname: Kasraeian
authors.affiliation: Florida Center for Prostate Care, Jacksonville, FL.
authors.forename: Jamie
authors.initials: J
authors.lastname: Cesaretti
authors.affiliation: Florida Center for Prostate Care, Jacksonville, FL.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kiley
authors.affiliation: Florida Center for Prostate Care, Jacksonville, FL.
authors.forename: Jason
authors.initials: J
authors.lastname: Koziol
authors.affiliation: Florida Center for Prostate Care, Jacksonville, FL.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Terk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Androgen suppression; Biochemical control; Biochemical failure; Brachytherapy; Castration resistant; Local failure; Outcome; Prostate cancer; Radiation therapy; Salvage therapy