title: Bladder wall recurrence of prostate cancer after high-dose-rate brachytherapy.
abstract: OBJECTIVE
  Prostate cancer seeding after needle biopsy has been reported in the perineum, rectal wall, and periprostatic soft tissue. In this article, we report the results of a localized prostate cancer recurrence in the bladder following protrusion of a single high-dose-rate brachytherapy catheter through the bladder wall at the ultimate site of failure.
  
  
  METHODS
  A 62-year-old man with high-risk prostate adenocarcinoma was treated with long-term androgen deprivation therapy, intensity-modulated radiation, and high-dose-rate brachytherapy boost. He developed biochemical recurrence 4 years after treatment, and a CT scan of the pelvis revealed a nodule in the posterior, inferior bladder wall.
  
  
  RESULTS
  Surgical pathology following transurethral resection of tumor within the bladder was consistent with high-grade prostate adenocarcinoma. The patient's prostate-specific antigen level fell to the range of normal postoperatively, and whole body imaging, including a multi-parametric MRI of the prostate with diffusion and spectroscopy, failed to reveal any other sites of disease. Review of the CT scan obtained for dosimetry at the time of brachytherapy demonstrated a lone catheter protruding through the bladder wall at the site of eventual recurrence. The tumor recurred in the bladder 12 months later, once more without evidence of disease within the prostate itself or distantly, and the patient was started on salvage androgen deprivation therapy.
  
  
  CONCLUSIONS
  This case is the first report of prostate cancer recurrence in the bladder wall after brachytherapy and raises questions about prostate cancer biology, brachytherapy technique, and the timing of brachytherapy boost relative to whole pelvic radiotherapy for prostate cancer.
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: David R
authors.initials: DR
authors.lastname: Raleigh
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: I-Chow
authors.initials: IC
authors.lastname: Hsu
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: Steve
authors.initials: S
authors.lastname: Braunstein
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Chang
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; Department of Anatomic Pathology, University of California San Francisco, San Francisco, CA; Department of Urology, University of California San Francisco, San Francisco, CA.
authors.forename: Jeffry P
authors.initials: JP
authors.lastname: Simko
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; Department of Urology, University of California San Francisco, San Francisco, CA. Electronic address: MRoach@radonc.ucsf.edu.
authors.forename: Mack
authors.initials: M
authors.lastname: Roach
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary*; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009360:Neoplastic Cells, Circulating; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000556:secondary*
keywords: Androgen deprivation; Brachytherapy; Circulating tumor cells; Prostate cancer; Tumor seeding