STUDY: Interesting End Option

JOURNAL: J Am Coll Surg. 2003;197:s91

AUTHORS: Robert E. Weiss

ABSTRACT: Brachytherapy is found to be beneficial for treating prostate cancer that recurs after external beam radiotherapy.

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COMMENTARY: Retrospective record review identified 20 consecutive patients from 1998 to the present who were treated with radioactive seed implantation. All patients had biopsy-proven recurrent localized prostate cancer and had a staging evaluation negative for imageable disease.

There were no major complications. At about one to two weeks after treatment, transient adverse effects included irritative bladder symptoms in 35% and erectile dysfunction in 25% of those who were potent before brachytherapy.

Although these symptoms were similar to those who have undergone primary brachytherapy, a higher proportion of patients (55%) developed urinary obstructive symptoms, including one patient who needed a long-term catheter.

Based on normalization of prostate-specific antigen (PSA) levels, four-year actuarial disease-free survival was 70%. Gleason grade, initial stage, and pre- and postimplant PSA levels were associated with better odds of biochemical disease-free survival.

"Transperineal fluoroscopic-guided and biplane ultrasound-guided salvage prostate brachytherapy provides a potentially curative treatment modality for patients with recurrent localized prostate cancer after 3-D conformal external beam therapy,".