SAN DIEGO, CA USA (UroToday.com) - Patients who locally fail primary external beam radiotherapy (EBRT) present a clinical dilemma as to the best way to pursue curative measures and preserve function, minimizing morbidity. Post-EBRT salvage prostatectomy is known to place patients at higher risk for urinary incontinence and other complications than upfront-radical prostatectomy.
The authors report on 69 consecutive patients treated with a salvage Pd-103 implant, for local failure of prostate cancer, as an alternative treatment modality. All patients had no evidence for metastatic disease, a rising PSA, and biopsy-proven, recurrent, localized prostate cancer at least 2-years after initial external radiotherapy. Patients received 100Gy with a Palladium (Pd-103) implant, and 89.9% of patients received androgen suppression for at least 6 months, starting before the implant, as part of their salvage therapy. Failure was defined as current nadir PSA plus 2 ng/ml from start of AS or radiologic evidence of distant failure. 5-year biochemical disease-free survival (DFS) was 73.8% for non-CRPC patients. Grade 3 genitourinary complications, including incontinence, occurred in 8.7%, and there were no grade 4 complications.
There were no GI grades 3, 4, or 5 complications, leading the authors to conclude side effects were limited and comparable to salvage surgery; therefore salvage brachytherapy is a safe, feasible alternative option for men in this complex patient population.
With the rates of complications limited and comparable to historic rates seen with salvage surgery, the authors conclude that salvage brachytherapy is a safe and feasible alternative option for treatment of men in this complex patient population.
Presented by Douglas Swartz, Carlos Vargas, Mitchell Terk, and Apoorva Vashi at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Anthony T. Corcoran, MD
