720 SALVAGE PALLADIUM BRACHYTHERAPY FOR LOCAL FAILURE AFTER INITIAL EXTERNAL RADIOTHERAPY FOR PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Advanced (I)1 Apr 2013720 SALVAGE PALLADIUM BRACHYTHERAPY FOR LOCAL FAILURE AFTER INITIAL EXTERNAL RADIOTHERAPY FOR PROSTATE CANCER Douglas Swartz, Carlos Vargas, Mitchell Terk, and Apoorva Vashi Douglas SwartzDouglas Swartz Jacksonville, FL More articles by this author , Carlos VargasCarlos Vargas Jacksonville, FL More articles by this author , Mitchell TerkMitchell Terk Jacksonville, FL More articles by this author , and Apoorva VashiApoorva Vashi Jacksonville, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.279AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Salvage brachytherapy for localized pathologic failure after primary external beam radiation (EBRT) is rarely used. This retrospective study presents the efficacy and safety of Palladium brachytherapy for patients with only a localized recurrence after external radiotherapy with minimum 5 year follow-up. METHODS Sixty-nine consecutive patients treated with a salvage pd-103 implant for local failure of prostate cancer were evaluated at our institution. All patients had a rising PSA and biopsy proven recurrent localized prostate cancer at least 2-years after initial external radiotherapy. All were negative for metastatic disease on imaging studies, including a bone scan and CT or MRI of the abdomen and pelvis. Patients who had a PSA >5.0 ng/ml on androgen suppression were considered castration resistant (CRPC). Patients were stratified into low, intermediate and high risk according to the NCCN guidelines. 100Gy was the prescribed dose with a Palladium (Pd-103) implant. 89.9% of patients received androgen suppression (AS) for at least 6 months starting before the implant as part of their salvage therapy. Failure was defined as current nadir PSA plus 2 ng/ml from start of AS or radiologic evidence of distant failure. The CTCAE version 4.0 was used to assess complications. RESULTS Median follow-up from the time of initial external radiotherapy was 12 years (3.5-23.5) and after salvage therapy 5.0 years (0.6-13.7). 5 year Biochemical control (BC) for low risk patients was 85.6%, intermediate risk patients 74.8%, and high risk patients 66%. Most patients were on AS at the time of salvage. 5-y BC was 73.8% for non-CRPC and 22% for castration resistant prostate cancer patients (<0.001). For non-CRPC patients, early treatment after PSA failure vs. delayed treatment on AS for 6 months or more was associated with significantly worse 5-y BC: 58.9% vs. 77.8% (p=0.05). PSA >10ng/ml was also predictive: 5-y BC 73.9% vs. 51.4% (p=0.02). Stage T2c had a worse outcome: 76.3% vs. 50%, although this was not statistically significant. No statistical differences were seen by comparing Gleason Score. Grade 3 genitourinary complications including incontinence occurred in 8.7% and there were no grade 4 complications. There were no GI grades 3, 4 or 5 complications. CONCLUSIONS Excellent biochemical control can be achieved with salvage palladium brachytherapy after a local recurrence of prostate cancer after initial external radiotherapy. Side effects are limited and comparable to salvage surgery therefore offering an alternative option. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e296 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Douglas Swartz Jacksonville, FL More articles by this author Carlos Vargas Jacksonville, FL More articles by this author Mitchell Terk Jacksonville, FL More articles by this author Apoorva Vashi Jacksonville, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...