Localized prostate cancer with pelvic arteriovenous malformation treated with low‐dose‐rate brachytherapy after transcatheter embolization: Two case reports

Abstract

Background We describe two patients who underwent low‐dose‐rate prostate brachytherapy after embolization for pelvic arteriovenous malformation. Case presentation Case 1: A 76‐year‐old man was referred for definitive treatment of intermediate‐risk prostate cancer (prostate‐specific antigen 8.667 ng/mL, cT2aN0M0, Gleason score 3 + 4 = 7). We planned low‐dose‐rate brachytherapy. However, magnetic resonance imaging and computed tomography demonstrated a large pelvic arteriovenous malformation. We performed embolization of the arteriovenous malformation before initiating treatment to lower the risk of rupture of the arteriovenous malformation during low‐dose‐rate brachytherapy. Case 2: A 69‐year‐old man was referred for the definitive treatment of high‐risk prostate cancer (prostate‐specific antigen 5.81 ng/mL, cT2aN0M0, Gleason score 4 + 4 = 8) with a pelvic arteriovenous malformation. Similar to Case 1, we performed embolization of the arteriovenous malformation before initiating treatment. In both cases, low‐dose‐rate brachytherapy could be performed without complications. Conclusions Low‐dose‐rate brachytherapy after transcatheter embolization of pelvic arteriovenous malformations can safely and effectively treat localized prostate cancer with pelvic arteriovenous malformations.

Congenital periprostatic pelvic arteriovenous malformation presenting as isolated pelvic pain and requiring endovascular embolization

“…They are usually located in the brain, lungs and kidney 1–5 . AVMs confined to the pelvis are rare, and twice as uncommon in males 1–4 …”

“…Pelvic AVMs can be incidental findings, 4,6 but are usually diagnosed during symptomatic workup. Symptoms vary from mild to severe, and can be isolated solitary versus a constellation of symptoms.…”

“…Thus, supplementation with contrast‐enhanced CT may be necessary. CT angiography is useful in determining the vascular anatomy and defining the extent of lesions during assessment and can also characterize progression and recurrence during follow‐up 1–7 …”

“…2,3 There are only a few literature reports that describe periprostatic AVMs. 1,[3][4][5] We report a 60-year-old man with congenital periprostatic pelvic AVM presenting with isolated pelvic pain treated by endovascular embolization.…”

“…They are usually located in the brain, lungs and kidney. [1][2][3][4][5] AVMs confined to the pelvis are rare, and twice as uncommon in males. [1][2][3][4] Pelvic AVMs can be incidental findings, 4,6 but are usually diagnosed during symptomatic workup.…”