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Safety and efficacy of salvage low-dose-rate brachytherapy for prostate bed recurrences following radical prostatectomy.

Kumar AM, Smith KL, Reddy CA, Stephans KL, Klein EA, Ciezki JP - J Contemp Brachytherapy (2015)

Bottom Line: After a median 35 months post-salvage follow up (range 10-81 months), patients had a median PSA nadir of 0.72 ng/ml (range 0.01-22.4).At 6 months post salvage, 90% of patients had a PSA below pre-salvage levels.There was a trend to improved biochemical relapse free survival for lower Gleason score and pre-salvage PSA, which may be indicative of the lack of or only low volume metastatic disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: To report efficacy in our series of nodular recurrences in the post-surgical bed that underwent salvage low-dose-rate (LDR) brachytherapy.

Material and methods: Patients with radical prostatectomy (RP) who had biochemical failure with nodular recurrence detected by DRE, ultrasound, and pelvic CT and then salvaged with LDR (125)I brachytherapy were included. Nodular recurrences were biopsy confirmed adenocarcinoma, and patients had no evidence of nodal or distant metastasis on imaging including bone scan. Follow up was at least every 6 months with a serial prostate specific antigen (PSA).

Results: Twelve patients had salvage LDR brachytherapy with median age 69 years (range 59-86) and median pre-salvage PSA of 4.22 ng/ml. Nodule biopsy Gleason score was 7, 8, or undifferentiated. Median rectal V100 was 0.00 cc. Compared to pre-salvage, patients reported no additional genitourinary (GU) toxicity. After a median 35 months post-salvage follow up (range 10-81 months), patients had a median PSA nadir of 0.72 ng/ml (range 0.01-22.4). At 6 months post salvage, 90% of patients had a PSA below pre-salvage levels. At last follow up, 4 patients had PSA control.

Conclusions: There was a trend to improved biochemical relapse free survival for lower Gleason score and pre-salvage PSA, which may be indicative of the lack of or only low volume metastatic disease. LDR brachytherapy is an effective salvage technique and can be considered in well selected patients allowing for dose escalation to the nodular recurrence.

No MeSH data available.


Related in: MedlinePlus

Biochemical relapse free survival (bRFS) after salvage brachytherapy by Nodule Gleason Score (n = 11)
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Figure 0002: Biochemical relapse free survival (bRFS) after salvage brachytherapy by Nodule Gleason Score (n = 11)

Mentions: Tabulated PSA follow-up appears in Table 1 and 2. One patient was on androgen deprivation before and after LDR brachytherapy, and was omitted from PSA follow-up analysis. Thus, out of 11 patients, 9 patients (81.8%) had an immediate PSA decrease after salvage treatment (Figure 1A). At 6 months post-LDR brachytherapy, 10 patients had 6 month or greater follow-up, and nine (90%) continued to have a post-salvage PSA that was lower than the pre-salvage PSA (Figure 1B). The one patient who had an increase at 6 months had a high pre-salvage PSA of 15.2 that continued to increase after salvage LDR brachytherapy. Median biochemical relapse free survival (bRFS) post-salvage was 23 months. At last follow-up, four patients had a lower PSA compared to pre-LDR brachytherapy (Figure 1C and Table 1). When stratifying by Gleason score (Figure 2), there was a trend for bRFS benefit for lower Gleason score. Median distant metastases-free survival was 55 months. Two patients subsequently had distant metastases in the pelvic lymph nodes at 17 and 55 months after salvage brachytherapy (Figure 3). At last follow-up, four patients (33%) were alive with no evidence of disease (ANED) with initial PSA (ng/ml) 6.5, 4.56, 3.91, and 2.36; these PSA values were not significantly different than the patients who had biochemical and/or distant failures.


Safety and efficacy of salvage low-dose-rate brachytherapy for prostate bed recurrences following radical prostatectomy.

Kumar AM, Smith KL, Reddy CA, Stephans KL, Klein EA, Ciezki JP - J Contemp Brachytherapy (2015)

Biochemical relapse free survival (bRFS) after salvage brachytherapy by Nodule Gleason Score (n = 11)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643733&req=5

Figure 0002: Biochemical relapse free survival (bRFS) after salvage brachytherapy by Nodule Gleason Score (n = 11)
Mentions: Tabulated PSA follow-up appears in Table 1 and 2. One patient was on androgen deprivation before and after LDR brachytherapy, and was omitted from PSA follow-up analysis. Thus, out of 11 patients, 9 patients (81.8%) had an immediate PSA decrease after salvage treatment (Figure 1A). At 6 months post-LDR brachytherapy, 10 patients had 6 month or greater follow-up, and nine (90%) continued to have a post-salvage PSA that was lower than the pre-salvage PSA (Figure 1B). The one patient who had an increase at 6 months had a high pre-salvage PSA of 15.2 that continued to increase after salvage LDR brachytherapy. Median biochemical relapse free survival (bRFS) post-salvage was 23 months. At last follow-up, four patients had a lower PSA compared to pre-LDR brachytherapy (Figure 1C and Table 1). When stratifying by Gleason score (Figure 2), there was a trend for bRFS benefit for lower Gleason score. Median distant metastases-free survival was 55 months. Two patients subsequently had distant metastases in the pelvic lymph nodes at 17 and 55 months after salvage brachytherapy (Figure 3). At last follow-up, four patients (33%) were alive with no evidence of disease (ANED) with initial PSA (ng/ml) 6.5, 4.56, 3.91, and 2.36; these PSA values were not significantly different than the patients who had biochemical and/or distant failures.

Bottom Line: After a median 35 months post-salvage follow up (range 10-81 months), patients had a median PSA nadir of 0.72 ng/ml (range 0.01-22.4).At 6 months post salvage, 90% of patients had a PSA below pre-salvage levels.There was a trend to improved biochemical relapse free survival for lower Gleason score and pre-salvage PSA, which may be indicative of the lack of or only low volume metastatic disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: To report efficacy in our series of nodular recurrences in the post-surgical bed that underwent salvage low-dose-rate (LDR) brachytherapy.

Material and methods: Patients with radical prostatectomy (RP) who had biochemical failure with nodular recurrence detected by DRE, ultrasound, and pelvic CT and then salvaged with LDR (125)I brachytherapy were included. Nodular recurrences were biopsy confirmed adenocarcinoma, and patients had no evidence of nodal or distant metastasis on imaging including bone scan. Follow up was at least every 6 months with a serial prostate specific antigen (PSA).

Results: Twelve patients had salvage LDR brachytherapy with median age 69 years (range 59-86) and median pre-salvage PSA of 4.22 ng/ml. Nodule biopsy Gleason score was 7, 8, or undifferentiated. Median rectal V100 was 0.00 cc. Compared to pre-salvage, patients reported no additional genitourinary (GU) toxicity. After a median 35 months post-salvage follow up (range 10-81 months), patients had a median PSA nadir of 0.72 ng/ml (range 0.01-22.4). At 6 months post salvage, 90% of patients had a PSA below pre-salvage levels. At last follow up, 4 patients had PSA control.

Conclusions: There was a trend to improved biochemical relapse free survival for lower Gleason score and pre-salvage PSA, which may be indicative of the lack of or only low volume metastatic disease. LDR brachytherapy is an effective salvage technique and can be considered in well selected patients allowing for dose escalation to the nodular recurrence.

No MeSH data available.


Related in: MedlinePlus