Can patients with recurrent high-risk prostate cancer after external beam radiotherapy (EBRT) be salvaged by low dose rate (LDR) brachytherapy: case report describing technique and application

Abstract

Management of local relapse in prostate cancer after initial treatment is a serious issue. Many salvage options exist for patients who have local recurrence after external beam radiotherapy. Low-doserate (LDR) brachytherapy (BT) is a treatment option for patients with a recurrence of prostate cancer after external beam radiotherapy (EBRT). However, the recurrence of high-risk prostate cancer usually precludes patients from salvage treatment. Case presentation: The author presents two successful cases by salvage LDR BT for recurrence of high risk prostate cancer after external beam EBRT. Case reports: Case 1: A 61 years old man with high risk prostate cancer presenting PSA of 61 ng/mL, Gleason's score 4+3, and clinical T3a disease. The patient received intensity modulated radiotherapy (IMRT) total dose of 74.8 Gy in 2009.PSA reached nadir of 0.938 ng/mL in 2011. Later on PSA kept on increasing and reached 2.604 ng/mL. MRI showed local recurrence in the right lobe of the prostate. Case 2: A 60 years old man with high risk prostate cancer presenting PSA of 13 ng/mL, Gleason score 4+3, and clinical T3a disease. The patient received EBRT total dose of 70 Gy in 2005. Both of the patients have stayed healthy with biochemical failure free state and without urinary and bowel troubles at seven years after salvage LDR BT. Technical points to successful salvage in these difficult cases are also reported in detail. In conclusion, salvage LDR BT can be a viable treatment option even for high-risk prostate cancer recurrence after EBRT.