title: Diagnosis and management of local recurrence after low-dose-rate brachytherapy.
abstract: OBJECTIVE
  To describe the diagnosis of local failure after prostate brachytherapy (BT) and treatment options when recurrence is present.
  
  
  METHODS
  Review of literature for local recurrence after prostate BT and salvage therapy was performed. A total of 6 patients with prostate-specific antigen increase were identified as local failures by transperineal mapping biopsy (TPMB) and treated with targeted focused therapy using cryoablation.
  
  
  RESULTS
  Local recurrence after prostate BT occurs in 2-20% and is dose dependent. The biologic effective dose greater than 200 Gy(2) is associated with a less than 2% recurrence rate. Confirmatory biopsy should include both the prostate and seminal vesicles, as prostate cancer can be found in 20% of the latter. The pathologist should be experienced in evaluating post-irradiation tissue because of the difficulty in distinguishing benign irradiated prostate from residual or recurrent tumor. Whole gland salvage, whether by prostatectomy or cryoablation, is associated with high complication rates. Focal therapy has fewer complications but accurate targeting remains a concern. Newer diagnostic and targeting modalities such as multiparametric MRI and TPMB offer improved opportunity to increase lesion identification and ablation. A TPMB approach, which incorporates new biopsy needle design and interactive targeting software, may offer the best avenue to true focused therapy.
  
  
  CONCLUSIONS
  Local recurrences after prostate BT are uncommon because of high delivered radiation dose. When present, improved lesion identification and targeting may be associated with better cancer control and lower morbidity.
authors.affiliation: Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY; Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: drnelsonstone@gmail.com.
authors.forename: Nelson N
authors.initials: NN
authors.lastname: Stone
authors.affiliation: Department of Pathology, North Shore Health System at Lenox Hill Hospital, New York, NY.
authors.forename: Pamela
authors.initials: P
authors.lastname: Unger
authors.affiliation: Department of Surgery, Division on Urology, The Anschutz Cancer Center, University of Colorado Health Sciences Center, Aurora, CO.
authors.forename: E David
authors.initials: ED
authors.lastname: Crawford
authors.affiliation: Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Stock
mesh_terms: D000368:Aged; D001706:Biopsy; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016879:Salvage Therapy / Q000379:methods
chemical_list: D017430:Prostate-Specific Antigen
keywords: Brachytherapy; Focal therapy; Prostate biopsy; Salvage therapy