title: Salvage partial brachytherapy for prostate cancer recurrence after primary brachytherapy.
abstract: OBJECTIVE
  To characterize local recurrence of prostate cancer and to assess the effect of salvage partial brachytherapy after primary 125-iodine low-dose rate brachytherapy with or without external beam radiotherapy in Japanese men.
  
  
  METHODS
  Between 2003 and 2010, a total of 616 consecutive patients underwent low-dose rate brachytherapy-based therapy for clinically localized prostate cancer at Jikei University Hospital in Tokyo, Japan. Biochemical recurrence occurred in 45 (7.3%) patients at a median of 30 months (range 11-93 months). A total of 20 patients subsequently underwent transperineal template prostatic biopsy; of those, eight had positive cores at the base of the prostate or at the seminal vesicles. These eight patients had underdosed areas identified at initial low-dose rate brachytherapy corresponding to the positive biopsy sites. All were confirmed to have only localized recurrence, and seven underwent salvage partial low-dose rate brachytherapy.
  
  
  RESULTS
  Median prostate-specific antigen nadir level in the eight patients with biopsy-proven local recurrence after initial low-dose rate brachytherapy was 0.75 ng/mL (range 0.39-2.06). The seven retreated patients tolerated the salvage partial low-dose rate brachytherapy well, and showed a decrease in prostate-specific antigen level at follow up. Two patients later developed biochemical and clinical progression at 11 and 13 months, respectively. Prostate-specific antigen level continued to be low in the remaining five patients. No significant genitourinary or gastrointestinal toxicity was encountered.
  
  
  CONCLUSIONS
  Salvage partial low-dose rate brachytherapy for biopsy-proven localized prostate cancer recurrence appears rational, technically feasible and safe. Optimal patient selection is of utmost importance for long-term success. Larger studies with longer follow up are warranted.
authors.affiliation: Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasaki
authors.forename: Masahito
authors.initials: M
authors.lastname: Kido
authors.forename: Kenta
authors.initials: K
authors.lastname: Miki
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kuruma
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Manabu
authors.initials: M
authors.lastname: Aoki
authors.forename: Shin
authors.initials: S
authors.lastname: Egawa
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D016879:Salvage Therapy; D017211:Treatment Failure
keywords: local recurrence; prostate cancer; salvage partial brachytherapy