Preview

Cancer Urology

Advanced search

Salvage high-dose rate brachytherapy for local recurrence of prostate cancer after radical prostatectomy

https://doi.org/10.17650/1726-9776-2023-19-4-86-96

Abstract

Background. The current need for optimization of salvage treatment methods is dictated by the growing expansion of indications for radical prostatectomy in many centers in the developed countries of the world.

Aim. To evaluate the effectiveness, toxicity, and technical characteristics of high-dose rate brachytherapy in treatment of local prostate cancer (PCa) recurrences after radical prostatectomy.

Materials and methods. Between January 2015 and December 2020, salvage high-dose rate brachytherapy was performed in 17 patients at the Russian Scientific Center of Roentgenology and Radiology for local recurrence of PCa after radical prostatectomy. All patients underwent multiparametric magnetic resonance imaging of the pelvis at the stage of primary diagnosis in order to determine macroscopic tissue component in the prostate bed area. To rule out regional and distant metastases, all patients underwent positron emission tomography with 18F- or 68Ga-labeled prostate-specific membrane antigen. All patients included in the study underwent perineal biopsy of the prostate bed and seminal vesicles.

Results. Median follow-up in the treatment group was 35.7 (24–54) months. Overall survival was 100 %. Prostatespecific antigen-specific survival was 88.2 %. There were no local recurrences of PCa in the treatment group. In patients with local PCa recurrence, significant predictors of treatment failure were the presence of clinically extremely high risk of progression at initial diagnosis (p = 0.003), development of biochemical relapse up to 24 months after main treatment (p = 0.001), and increased blood level of prostate-specific antigen above 10 ng/mL during registration of biochemical relapse (p = 0.002).

Conclusion. High-dose rate brachytherapy is a safe and effective salvage treatment for local recurrence of PCa after radical prostatectomy. In addition to the brachytherapy technique, the diagnostic stage is also of great importance providing visualization of the exact location of tumor recurrence.

About the Authors

V. A. Solodkiy
Russian Scientific Center of Roentgenradiology, Ministry of Health of Russia
Russian Federation

Vladimir A. Solodkiy, Doctor of Sciences in Medicine, Professor, Academician of the Russian Academy of Sciences, Director 

86 Profsoyuznaya St., Moscow 117997

 



A. Yu. Pavlov
Russian Scientific Center of Roentgenradiology, Ministry of Health of Russia
Russian Federation

Andrei Yu. Pavlov, Doctor of Sciences in Medicine, Professor, Deputy Director

86 Profsoyuznaya St., Moscow 117997

 



A. G. Dzidzaria
Russian Scientific Center of Roentgenradiology, Ministry of Health of Russia
Russian Federation

Doctor of Sciences in Medicine, Head of the Department of Oncourology

86 Profsoyuznaya St., Moscow 117997



A. D. Tsibulskii
Russian Scientific Center of Roentgenradiology, Ministry of Health of Russia
Russian Federation

Aleksey D. Tsibulskii, Doctor of Sciences in Medicine, Leading Researcher 

86 Profsoyuznaya St., Moscow 117997



References

1. Siegel R.L., Miller K.D., Wagle N.S., Jemal A. Cancer statistics, 2023. CA Cancer J Clin 2023;73(1):17–48. DOI: 10.3322/caac.21763

2. Huang J., On-Ting Chan E., Liu X. et al. Global trends of prostate cancer by age, and their associations with Gross Domestic Product (GDP), Human Development Index (HDI), smoking, and alcohol drinking. Clin Genitourin Cancer 2023;21(4):e261–70. DOI: 10.1016/j.clgc.2023.02.003

3. Roberts M.J., Chatfield M.D., Hruby G. et al. Event-free survival after radical prostatectomy according to PSMA PET and EAU Biochemical Recurrence Risk Groups. BJU Int 2022;130(Suppl 3): 32–9. DOI: 10.1111/bju.15762

4. Petrovskii N.V., Glybochko P.V., Alyaev Yu.G. et al. Local recurrence of prostate cancer after radical prostatectomy. Urologiya = Urologiia 2017;(4):85–90. (In Russ.). DOI: 10.18565/urol.2017.4.85-90

5. Pound C.R., Partin A.W., Eisenberger M.A. et al. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999;281(17):1591–7. DOI: 10.1001/jama.281.17.1591

6. Moreira D.M., Presti J.C., Aronson W.J. et al. Natural history of persistently elevated prostate specific antigen after radical prostatectomy: results from the SEARCH database. J Urol 2009;182(5):2250–5. DOI: 10.1016/j.juro.2009.07.022

7. Preisser F., Chun F.K.H., Pompe R.S. et al. Persistent prostatespecific antigen after radical prostatectomy and its impact on oncologic outcomes. Eur Urol 2019;76(1):106–14. DOI: 10.1016/j.eururo.2019.01.048

8. Sugino F., Nakane K., Kawase M. et al. Biochemical recurrence after chemohormonal therapy followed by robot-assisted radical prostatectomy in very-high-risk prostate cancer patients. J Robot Surg 2023;17(5):2441–9. DOI: 10.1007/s11701-023-01670-3

9. Le Guevelou J., Magne N., Counago F. et al. Stereotactic body radiation therapy after radical prostatectomy: current status and future directions. World J Urol 2023;41(11):3333–44. DOI: 10.1007/s00345-023-04605-7

10. Falagario U.G., Abbadi A., Remmers S. et al. Biochemical recurrence and risk of mortality following radiotherapy or radical prostatectomy. JAMA Netw Open 2023;6(9):e2332900. DOI: 10.1001/jamanetworkopen.2023.32900

11. Furrer M.A., Sathianathen N., Gahl B. et al. Oncological outcomes after attempted nerve-sparing radical prostatectomy (NSRP) in patients with high-risk prostate cancer are comparable to standard non-NSRP: a longitudinal long-term propensity-matched singlecentre study. BJU Int 2024;133(1):53–62. DOI: 10.1111/bju.16126

12. Ploussard G., Fossati N., Wiegel T. et al. Management of persistently elevated prostate-specific antigen after radical prostatectomy: a systematic review of the literature. Eur Urol Oncol 2021;4(2): 150–69. DOI: 10.1016/j.euo.2021.01.001

13. Buchser D., Gomez-Iturriaga A., Melcon I. et al. Salvage highdose-rate brachytherapy for histologically confirmed macroscopic local relapsed prostate cancer after radical prostatectomy. J Contemp Brachytherapy 2016;8(6):477–83. DOI: 10.5114/jcb.2016.64441

14. Petersen P.M., Cook A.D., Sydes M.R. et al. Salvage radiation therapy after radical prostatectomy: analysis of toxicity by dosefractionation in the RADICALS-RT trial. Int J Radiat Oncol Biol Phys 2023;117(3):624–9. DOI: 10.1016/j.ijrobp.2023.04.032

15. Benziane-Ouaritini N., Zilli T., Giraud A. et al. Prostatectomy bed image-guided dose-escalated salvage radiotherapy (SPIDER): an international multicenter retrospective study. Eur Urol Oncol 2023;6(4):390–8. DOI: 10.1016/j.euo.2023.02.013

16. Thompson I.M., Valicenti R.K., Albertsen P. et al. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol 2013;190(2):441–9. DOI: 10.1016/j.juro.2013.05.032

17. Morton G., McGuffin M., Chung H.T. et al. Prostate high doserate brachytherapy as monotherapy for low and intermediate risk prostate cancer: Efficacy results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy. Radiother Oncol 2020;146:90–6. DOI: 10.1016/j.radonc.2020.02.009

18. Johansson B., Olsén J.S., Karlsson L. et al. High-dose-rate brachytherapy as monotherapy for low- and intermediate-risk prostate cancer: long-term experience of Swedish single-center. J Contemp Brachytherapy 2021;13(3):245–53. DOI: 10.5114/jcb.2021.105846

19. NCCN guidelines insights. Prostate cancer, version 1.2023. Available at: https://education.nccn.org.

20. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2023. ISBN 978-94-92671-19-6.

21. Clinical guidelines. Prostate cancer, 2021–2022–2023 (20.01.2023). Available at: http://disuria.ru. (In Russ.).

22. Strouthos I., Karagiannis E., Zamboglou N., Ferentinos K. Highdose-rate brachytherapy for prostate cancer: Rationale, current applications, and clinical outcome. Cancer Rep (Hoboken) 2021;5(1):e1450. DOI: 10.1002/cnr2.1450

23. Sargos P., Chabaud S., Latorzeff I. et al. Adjuvant radiotherapy versus early salvage radiotherapy plus short-term androgen deprivation therapy in men with localised prostate cancer after radical prostatectomy (GETUG-AFU 17): a randomised, phase 3 trial. Lancet Oncol 2020;21(10):1341–52. DOI: 10.1016/S1470-2045(20)30454-X

24. Staal F.H.E., Janssen J., Brouwer C.L. et al. Phase III randomised controlled trial on PSMA PET/CT guided hypofractionated salvage prostate bed radiotherapy of biochemical failure after radical prostatectomy for prostate cancer (PERYTON-trial): study protocol. BMC Cancer 2022;22(1):416. DOI: 10.1186/s12885-022-09493-5

25. Soror T., Melchert C., Rades D. et al. Salvage high-dose-rate interventional radiotherapy (brachytherapy) for locally relapsed prostate cancer after radical prostatectomy and subsequent external irradiation. J Contemp Brachytherapy 2023;15(3):159–65. DOI: 10.5114/jcb.2023.128845


Review

For citations:


Solodkiy V.A., Pavlov A.Yu., Dzidzaria A.G., Tsibulskii A.D. Salvage high-dose rate brachytherapy for local recurrence of prostate cancer after radical prostatectomy. Cancer Urology. 2023;19(4):86-96. (In Russ.) https://doi.org/10.17650/1726-9776-2023-19-4-86-96

Views: 301


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1726-9776 (Print)
ISSN 1996-1812 (Online)
X