Salvage brachytherapy for recurrent prostate cancer

Published:December 02, 2013DOI:



      To evaluate the role of salvage prostate brachytherapy for locally recurrent prostate cancer after external beam radiation alone.

      Methods and Materials

      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.


      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.


      A subset of failures after definitive radiation is local in nature, and excellent control is possible with salvage brachytherapy.


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        • Sharifi N.
        • Gulley J.L.
        • Dahut W.L.
        Androgen deprivation therapy for prostate cancer.
        JAMA. 2005; 294: 238-244
        • Swanson G.P.
        • Hussey M.A.
        • Tangen C.M.
        • et al.
        Predominant treatment failure in postprostatectomy patients is local: Analysis of patterns of treatment failure in SWOG 8794.
        J Clin Oncol. 2007; 25: 2225-2229
        • Thompson I.M.
        • Tangen C.M.
        • Paradelo J.
        • et al.
        Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: Long-term followup of a randomized clinical trial.
        J Urol. 2009; 181: 956-962
        • Van der Kwast T.H.
        • Bolla M.
        • Van P.H.
        • et al.
        Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911.
        J Clin Oncol. 2007; 25: 4178-4186
        • Vargas C.
        • Kestin L.L.
        • Weed D.W.
        • et al.
        Improved biochemical outcome with adjuvant radiotherapy after radical prostatectomy for prostate cancer with poor pathologic features.
        Int J Radiat Oncol Biol Phys. 2005; 61: 714-724
        • Wiegel T.
        • Bottke D.
        • Steiner U.
        • et al.
        Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95.
        J Clin Oncol. 2009; 27: 2924-2930
        • Fuks Z.
        • Leibel S.A.
        • Wallner K.E.
        • et al.
        The effect of local control on metastatic dissemination in carcinoma of the prostate: Long-term results in patients treated with 125I implantation.
        Int J Radiat Oncol Biol Phys. 1991; 21: 537-547
        • Kuban D.A.
        • el-Mahdi A.M.
        • Schellhammer P.F.
        Effect of local tumor control on distant metastasis and survival in prostatic adenocarcinoma.
        Urology. 1987; 30: 420-426
        • Burri R.J.
        • Stone N.N.
        • Unger P.
        • et al.
        Long-term outcome and toxicity of salvage brachytherapy for local failure after initial radiotherapy for prostate cancer.
        Int J Radiat Oncol Biol Phys. 2010; 77: 1338-1344
        • Grado G.L.
        • Collins J.M.
        • Kriegshauser J.S.
        • et al.
        Salvage brachytherapy for localized prostate cancer after radiotherapy failure.
        Urology. 1999; 53: 2-10
        • Bianco Jr, F.J.
        • Scardino P.T.
        • Stephenson A.J.
        • et al.
        Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy.
        Int J Radiat Oncol Biol Phys. 2005; 62: 448-453
        • Izawa J.I.
        • Madsen L.T.
        • Scott S.M.
        • et al.
        Salvage cryotherapy for recurrent prostate cancer after radiotherapy: Variables affecting patient outcome.
        J Clin Oncol. 2002; 20: 2664-2671
        • Vargas C.
        • Swartz D.
        • Vashi A.
        • et al.
        Long-term outcomes and prognostic factors in patients treated with intraoperatively planned prostate brachytherapy.
        Brachytherapy. 2013; 12: 120-125
        • Viani G.A.
        • da Silva L.G.
        • Stefano E.J.
        High-dose conformal radiotherapy reduces prostate cancer-specific mortality: Results of a meta-analysis.
        Int J Radiat Oncol Biol Phys. 2012; 83: e619-e625
        • Vargas C.E.
        • Martinez A.A.
        • Boike T.P.
        • et al.
        High-dose irradiation for prostate cancer via a high-dose-rate brachytherapy boost: Results of a phase I to II study.
        Int J Radiat Oncol Biol Phys. 2006; 66: 416-423
        • Grimm P.
        • Billiet I.
        • Bostwick D.
        • et al.
        Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group.
        BJU Int. 2012; 109: 22-29
        • Walz J.
        • Joniau S.
        • Chun F.K.
        • et al.
        Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy.
        BJU Int. 2011; 107: 765-770
        • Menon M.
        • Bhandari M.
        • Gupta N.
        • et al.
        Biochemical recurrence following robot-assisted radical prostatectomy: Analysis of 1384 patients with a median 5-year follow-up.
        Eur Urol. 2010; 58: 838-846
        • Bolla M.
        • Van P.H.
        • Tombal B.
        • et al.
        Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: Long-term results of a randomised controlled trial (EORTC trial 22911).
        Lancet. 2012; 380: 1974-1976
        • Zelefsky M.J.
        • Reuter V.E.
        • Fuks Z.
        • et al.
        Influence of local tumor control on distant metastases and cancer related mortality after external beam radiotherapy for prostate cancer.
        J Urol. 2008; 179: 1368-1373
        • Stone N.N.
        • Stock R.G.
        • White I.
        • et al.
        Patterns of local failure following prostate brachytherapy.
        J Urol. 2007; 177: 1759-1763
        • Kestin L.L.
        • Goldstein N.S.
        • Vicini F.A.
        • et al.
        Pathologic evidence of dose-response and dose-volume relationships for prostate cancer treated with combined external beam radiotherapy and high-dose-rate brachytherapy.
        Int J Radiat Oncol Biol Phys. 2002; 54: 107-118
        • Langsenlehner T.
        • Renner W.
        • Gerger A.
        • et al.
        Association between single nucleotide polymorphisms in the gene for XRCC1 and radiation-induced late toxicity in prostate cancer patients.
        Radiother Oncol. 2011; 98: 387-393
        • Scher H.I.
        • Sawyers C.L.
        Biology of progressive, castration-resistant prostate cancer: Directed therapies targeting the androgen-receptor signaling axis.
        J Clin Oncol. 2005; 23: 8253-8261
        • Smith M.R.
        • Saad F.
        • Coleman R.
        • et al.
        Denosumab and bone-metastasis-free survival in men with castration-resistant prostate cancer: Results of a phase 3, randomised, placebo-controlled trial.
        Lancet. 2012; 379: 39-46