Salvage Reimplantation in Patient with Local Recurrent Prostate Carcinoma after Brachytherapy with Three Dimensional Computed Tomography-Guided Permanent Pararectal Implant

Abstract

Thirty-one [31] patients with local recurrent or residual adenocarcinoma of the prostate, with no evidence of distant metastases, were treated with second permanent implant using a stereotactic three dimensional system and posterior pararectal CT-guided method. All patients had extensive under local anesthesia or IV sedation pararectal CT-guided biopsy of the prostate and seminal vesicles. All patients except one had 3 month neoadjuvant androgen ablation prior to salvage reimplantation. Twenty [20] of these patients had local recurrence in the prostate and eleven [11] patients had seminal vesicle invasion which was not diagnosed nor treated with the initial brachytherapy. In addition, the patients had PSA failure or local palpable disease, “cold spots” with CT imaging or areas of dosage less than 80% of the prescribed dose with DVH (dose volume histogram). Initial prescribed dose was 120 Gy with¹⁰³ Pd loose seeds in 26 patients and 144 Gy with¹²⁵ I loose seeds in 5 patients. For the reimplant the dosage in the recurrent site was 100–144 Gy with¹²⁵ I seeds in strand in 24 patients (77%) and 100–120 Gy with¹⁰³ Pd loose seeds in 7 patients (23%). The preference of¹²⁵ I seeds in the second treatment was because only¹²⁵ I in strand was available at the time of the reimplant. Eleven [11] patients had second implant twelve to twenty-four months after the initial implant and 20 patients had after twenty-five to eighty-seven months and median follow-up was thirty months. A high level of biochemical control (87%) was achieved in all of these patients who are recognized as high risk due to local recurrence. Four [4] patients experienced grade 2 or 3 GI or GU complications and two [2] patients experienced grade 4 GI complications. Patients with local recurrent prostate cancer following initial brachytherapy including those with seminal vesicle invasion can be successfully treated with pararectal stereotactic CT-guided reimplantation. Assessment of seminal vesicle status is an essential part of staging for local recurrence.

Keywords

Prostate cancer Salvage brachytherapy Reimplant Computed tomography Pararectal

References

Grimm

P. D.

, Blasko

J. C.

, Sylvester

J. E.

10-year Biochemical (Prostate-specific Antigen) Control of Prostate Cancer with I 125 Brachytherapy. Int. J. Radiation Oncology Biol. Phys. 51, 31–40 (2001).

Koutrouvelis

P. G.

Three-Dimensional Stereotactic Posterior Ischiorectal Space Computerized Tomography Guided Brachytherapy of Prostate Cancer: A Preliminary Report. J. Urol. 159, 142–145 (1998).

Koutrouvelis

P. G.

, Lailas

, Goldson

3-D CT-guided Brachytherapy for Localized Prostate Cancer in Patients with Large Volumes: 5-year Follow-up. J. Brachytherapy Int. 16, 1–10 (2000).

Koutrouvelis

P. G.

, Lailas

, Katz

Prostate Cancer with Large Glands Treated with 3-dimensional Computerized Tomography Guided Pararectal Brachytherapy: Up to 8 Years of Followup. J. Urol. 169, 1331–1336 (2003).

Koutrouvelis

P. G.

, Lailas

, Hendricks

Three Dimensional Computed Tomography-guided Monotherapeutic Pararectal Brachytherapy of Prostate Cancer with Seminal Vesicle Invasion. Radiotherapy and Oncology 60, 31–35 (2001).

Collet

Modelling Survival Data in Medical Research. Chapman & Hall (1994).

Kaplan

E. L.

, Meier

Nonparametric Estimation from Incomplete Observations. J. American Statistical Association 53, 457–459, (1958).

Wallner

K. E.

, Nori

, Morse

M. J.

. Iodine 125 Reimplantation for Locally Progressive Prostatic Carcinoma. J. Urology 144, 704–706 (1990).

Brenner

P. C.

, Russo

, Wood

D. P.

Salvage Radical Prostatectomy in the Management of Locally Recurrent Prostate Cancer after 125I Implantation. British J. of Urol. 75, 44–7 (1995).

10.

Lee

A. K.

, Schultz

, Renshaw

A. A.

Optimizing Patient Selection for Prostate Monotherapy. Int. J. Radiation Oncology Biol. Phys. 49, 673–677 (2001).

11.

Debras

, Guillonneau

, Bougaran

Prognostic Significance of Seminal Vesicle Invasion on the Radical Prostatectomy Specimen. Rationale for Seminal Vesicle Biopsies. Eur. Urol. 33, 271–7 (1998).

12.

Epstein

, Partin

, Sauvageot

Prediction of Progression Following Radical Prostatectomy. A Multivariate Analysis of 721 Men with Long-term Follow-up. Am. J. Surg. Pathol. 20, 286–292 (1996).

13.

Moul

J. W.

, Connelly

R. R.

, Lubeck

D. P.

Predicting Risk of Prostate Specific Antigen Recurrence After Radical Prostatectomy with the Center for Prostate Disease Research and Cancer of the Prostate Strategic Urologic Research Endeavor Databases. J. Urol. 166, 1322–1327 (2001).

14.

Potter

S. R.

, Epstein

J. I.

, Partin

A. W.

Seminal Vesicle Invasion by Prostate Cancer: Prognostic Significance and Therapeutic Implications. Rev. Urol. 2, 190–195 (2000).

15.

Valicenti

R. K.

, Gomella

L. G.

, Ismail

Pathologic Seminal Vesicle Invasion after Radical Prostatectomy for Patients with Prostate Carcinoma: Effect of Early Adjuvant Radiation Therapy on Biochemical Control. Cancer 82, 1909–1914 (1998).

16.

Stock

R. G.

, Lo

Y. C.

, Gaildon

Does Prostate Brachytherapy Treat the Seminal Vesicles? A Dose-volume Histogram Analysis of Seminal Vesicles in Patients Undergoing Combined Pd-103 Prostate Implantation and External Beam Irradiation. Int. J. Radiat. Oncol. Biol. Phys. 45, 385–389 (1999).

17.

Merrick

G. S.

, Butler

W. M.

, Galbreath

R. W.

Prostate-specific Antigen Spikes After Permanent Prostate Brachytherapy. Int. J. Radiation Oncology Biol. Phys. 54, 450–6 (2002).

18.

Rosser

C. J.

, Kuban

D. A.

, Levy

L. B.

Prostate Specific Antigen Bounce Phenomenon After External Beam Radiation for Clinically Localized Prostate Cancer. J. Urol. 168, 2001–2005 (2002).

19.

Critz

F. A.

, Williams

W. H.

, Benton

J. B.

Prostate Specific Antigen Bounce After Radioactive Seed Implantation Followed by External Beam Radiation for Prostate Cancer. J. Urol. 163, 1085–1089 (2000).