Salvage brachytherapy for recurrent prostate cancer after definitive radiation therapy: A comparison of low-dose-rate and high-dose-rate brachytherapy and the importance of prostate-specific antigen doubling time

Kollmeier, Marisa A.; McBride, Sean; Taggar, Amandeep; Anderson, Erik S.; Lin, Mingjie; Pei, Xin; Shi, Wei; Voros, Laszlo; Cohen, Gil’ad N.; Yamada, Yoshiya; Zeléfsky, Michael J.

doi:10.1016/j.brachy.2017.07.013

Cited by 71 publications

(46 citation statements)

References 21 publications

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“…19 That noted, our incidence of grade 3þ GU toxicity does not exceed that reported in de novo or salvage HDR literature. 15,16,18,[30][31][32][33] Our serious GU complication rate appears considerably less than that reported with salvage radical prostatectomy, with one contemporary salvage RP series reporting 35% grade 3 or higher complications and another salvage RP literature review series quoting up to 25% such incidence, versus our own incidence of 8% including all prior RT risk categories and 3% poststandard EBRT salvage. 8,9 The incidence of GI toxicity greater than grade 1 in this series is zero, with more than adequate median follow-up duration in this series (nearly 4 years) to properly evaluate this risk condition, indicating that this SBRT method is at least as safe from a GI toxicity viewpoint as any other local salvage method.…”

Section: Toxicity and Complicationsmentioning

confidence: 51%

“…The 60% 5-year bRFS in this series is within the 45% to 78% range of reported 5-year salvage brachytherapy results. 12,[15][16][17][18][27][28][29][30][31][32][33] As previously described in great detail, the dose morphology in this protocol was designed to replicate that of HDR brachytherapy such that brachytherapy equivalence is expected and reasonably demonstrated herein. 19 We also report a biochemical relapse-free efficacy rate that appears at least comparable to that reported with salvage radical prostatectomy (RP); 60% 5-year bRFS in the present series versus 57% 3-year bRFS in a contemporary salvage RP series of similar size and similar median follow-up.…”

Section: Psa Response and Disease-free Survivalmentioning

confidence: 99%

“…14 Lastly, high dose-rate (HDR) brachytherapy appears effective, although primarily performed at a few high volume tertiary centers and thus not widely available or practiced. [15][16][17][18] One institute with experience in LDR and HDR techniques reported a lower incidence of severe peak urinary symptoms with HDR brachytherapy, although recovery was typically seen by 3 years with both modalities. 18 Prostate stereotactic body radiation therapy (SBRT) is a more contemporary method, which may be made to effectively recapitulate "HDR-like" dose morphology, with the advantage of being noninvasive and increasingly available.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17][18] One institute with experience in LDR and HDR techniques reported a lower incidence of severe peak urinary symptoms with HDR brachytherapy, although recovery was typically seen by 3 years with both modalities. 18 Prostate stereotactic body radiation therapy (SBRT) is a more contemporary method, which may be made to effectively recapitulate "HDR-like" dose morphology, with the advantage of being noninvasive and increasingly available. 19 Thus, SBRT is a potentially viable newer option to treat local recurrence.…”

Section: Introductionmentioning

confidence: 99%

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Retreatment for Local Recurrence of Prostatic Carcinoma After Prior Therapeutic Irradiation: Efficacy and Toxicity of HDR-Like SBRT

Fuller

Wurzer

Shirazi

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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Conclusions: SBRT salvage of local prostate recurrence in previously irradiated patients appears clinically feasible in this challenging group. It demonstrates favorable PSA and DFS response, typically deferring the need for salvage androgen deprivation therapy or other treatment by over 5 years, with low GU and GI toxicity. Ó 2019 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Abbreviations: ADT Z androgen deprivation therapy; EBRT Z external beam radiation therapy; RT Z radiotherapy; SBRT Z stereotactic body radiation therapy. Volume 106 Number 2 2020Local recurrent prostate cancer SBRT salvage 293

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Section: Toxicity and Complicationsmentioning

confidence: 51%

Section: Psa Response and Disease-free Survivalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Retreatment for Local Recurrence of Prostatic Carcinoma After Prior Therapeutic Irradiation: Efficacy and Toxicity of HDR-Like SBRT

Fuller

Wurzer

Shirazi

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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“…On multivariate analysis, only the PSA doubling time less than 12 months was significantly associated with PSA relapse. 118 Salvage High-Intensity Focused Ultrasound for Recurrent Prostate Cancer Salvage HIFU which targets focused ultrasound energy to a specific area has been used for primary prostate cancer treatment and for salvage therapy. Salvage HIFU is relatively recent treatment modality with limited studies on its efficacy.…”

Section: Salvage Radiation For Recurrent Prostate Cancermentioning

confidence: 99%

Magnetic Resonance–Guided Prostate Ablation

Woodrum

Kawashima

Gorny

et al. 2019

Semin intervent Radiol

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In 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade “localized” prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.

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Observer preference of artificial intelligence‐generated versus clinical prostate contours for ultrasound‐based high dose rate brachytherapy

King,

Kehayias,

Chaunzwa

et al. 2023

Medical Physics

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BackgroundFor trans‐rectal ultrasound (TRUS)‐based high dose rate (HDR) prostate brachytherapy, prostate contouring can be challenging due to artifacts from implanted needles, bleeding, and calcifications.PurposeTo evaluate the geometric accuracy and observer preference of an artificial intelligence (AI) algorithm for generating prostate contours on TRUS images with implanted needles.MethodsWe conducted a retrospective study of 150 patients, who underwent HDR brachytherapy. These patients were randomly divided into training (104), validation (26) and testing (20) sets. An AI algorithm was trained/validated utilizing the TRUS image and reference (clinical) contours. The algorithm then provided contours for the test set. For evaluation, we calculated the Dice coefficient between AI and reference prostate contours. We then presented AI and reference contours to eight clinician observers, and asked observers to select their preference. Observers were blinded to the source of contours. We calculated the percentage of cases in which observers preferred AI contours. Lastly, we evaluate whether the presence of AI contours improved the geometric accuracy of prostate contours provided by five resident observers for a 10‐patient subset.ResultsThe median Dice coefficient between AI and reference contours was 0.92 (IQR: 0.90–0.94). Observers preferred AI contours for a median of 57.5% (IQR: 47.5, 65.0) of the test cases. For resident observers, the presence of AI contours was associated with a 0.107 (95% CI: 0.086, 0.128; p < 0.001) improvement in Dice coefficient for the 10‐patient subset.ConclusionThe AI algorithm provided high‐quality prostate contours on TRUS with implanted needles. Further prospective study is needed to better understand how to incorporate AI prostate contours into the TRUS‐based HDR brachytherapy workflow.

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Salvage brachytherapy for recurrent prostate cancer after definitive radiation therapy: A comparison of low-dose-rate and high-dose-rate brachytherapy and the importance of prostate-specific antigen doubling time

Cited by 71 publications

References 21 publications

Retreatment for Local Recurrence of Prostatic Carcinoma After Prior Therapeutic Irradiation: Efficacy and Toxicity of HDR-Like SBRT

Retreatment for Local Recurrence of Prostatic Carcinoma After Prior Therapeutic Irradiation: Efficacy and Toxicity of HDR-Like SBRT

Magnetic Resonance–Guided Prostate Ablation

Observer preference of artificial intelligence‐generated versus clinical prostate contours for ultrasound‐based high dose rate brachytherapy

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