Perineal recurrence of prostate cancer post-brachytherapy

Abstract

We present a rare case of perineal recurrence of prostate cancer post low dose rate brachytherapy. Increased levels of prostate-specific antigen were recorded 12 years post brachytherapy. Pelvic CT and MRI visualized a nodular lesion in the perineum, and positron emission tomography demonstrated choline-avidity. Ultrasound-guided biopsy of the nodule was performed, yielding histology consistent with prostatic adenocarcinoma. Metastatic prostatic seeding to the perineum is a rare complication of brachytherapy. We discuss the putative mechanism, approach to diagnosis, and management.

Successful Stereotactic Body Radiation Therapy for Postbrachytherapy Prostate Recurrence and Penile Bulb Metastasis

“…Thus, perineal recurrence is considered to have a poor prognosis. Perineal recurrence after prior prostate brachytherapy is a rare event, with only four prior reports available (15)(16)(17)(18).…”

Perineal recurrence of prostate ductal adenocarcinoma after transperineal brachytherapy: a case report and literature review

“…The literature search restricted the language to English and the search terms included “prostate cancer”, “brachytherapy”, and “perineal”. Only three cases of perineal recurrence after brachytherapy were identified [ 6 , 7 , 8 ]. Hence, the incidence of perineal recurrence after brachytherapy is undetermined.…”

“…Then, ADT started after radiation therapy. In another previously reported case, the nodule had become too small after ADT to accurately place fiducial markers, and a CyberKnife ablation could not performed [ 6 ]. Therefore, the time of ADT initiation should be considered carefully in patients for whom radiation therapy is planned.…”

“…The authors reported that distant metastases were discovered simultaneously or within 16 months in all patients, who died within a median of 36 months after the initial diagnosis [ 2 ]. The previously reported 2 cases with a perineal recurrence after LDR-BT showed a good response to VMAT and ADT [ 6 , 7 ]. However, the observation period was too short to determine their prognosis.…”

Salvage high-dose-rate interstitial brachytherapy for perineal recurrence of prostate cancer after surgery and radiotherapy: a case report

“…Perineal seeding of tumor cells from prostate cancer (PCa) is very rare and no standard treatment exists for this atypical presentation with no evidence of distant metastases, including those occurring after biopsy, surgery, cryotherapy, or interstitial brachytherapy (BT) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Local excision is commonly used as local salvage treatments for such perineal masses.…”