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 Journal Article


Authors: Kollmeier, M. A.; McBride, S.; Taggar, A.; Anderson, E.; Lin, M.; Pei, X.; Weiji, S.; Voros, L.; Cohen, G.; Yamada, Y.; Zelefsky, M. J.
Article Title: 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
Abstract: Background Salvage brachytherapy is a treatment option for patients with locally recurrent prostate cancer after primary radiation therapy. We reviewed our experience using low-dose-rate (LDR) or high-dose-rate (HDR) brachytherapy to compare the outcome and toxicity profiles of each approach in the salvage brachytherapy setting. Methods and Materials Ninety-eight patients with biopsy-proven locally recurrent prostate cancer who underwent salvage brachytherapy (LDR = 37; HDR = 61) following an initial course of definitive radiotherapy between 4/2003 and 4/2015 were retrospectively reviewed. All patients underwent salvage brachytherapy using LDR or HDR. Androgen deprivation therapy was used in 45% of the patients. Prostate-specific antigen (PSA) failure was determined using the Phoenix (nadir+2) definition. Toxicity was graded using Common Terminology Criteria for Adverse Events version 4 and patient-reported questionnaires. Results Median followup was 31 months. The 3-year PSA relapse-free survival (RFS) was 60.1% (95% CI, 49.6–72.5%). There was no difference between LDR and HDR brachytherapy in terms of PSA RFS (p = 0.84 by log-rank test). On multivariate analysis, only prostate-specific antigen doubling time (PSADT) <12 months was significantly associated with PSA relapse. The 3-year PSA RFS for patients with a PSADT <12 months was 39% compared with 73% for PSADT ≥12 months (p = 0.002 by long-rank test). There were no statistically significant differences in toxicity between LDR and HDR brachytherapy. There was a higher peak in urinary symptoms in LDR patients; however by 24–36 months, most patients in both groups returned to baseline. Conclusions Both LDR and HDR salvage brachytherapy are an excellent treatment options for appropriately selected patients with comparable outcome and toxicity. Patients with a PSADT < 12 months seem to have worse outcomes. © 2017 American Brachytherapy Society
Keywords: adult; cancer survival; controlled study; aged; treatment failure; major clinical study; cancer recurrence; salvage therapy; treatment duration; cancer radiotherapy; comparative study; radiation dose; outcome assessment; follow up; prostate specific antigen; disease association; phase 2 clinical trial; clinical assessment; relapse; radiation injury; retrospective study; hematuria; prostate cancer; questionnaire; gastrointestinal toxicity; iodine 125; urine incontinence; prostate biopsy; urinary frequency; brachytherapy; recurrent disease; intermethod comparison; therapy effect; urinary urgency; personal experience; androgen deprivation therapy; urine retention; biochemical recurrence; palladium 103; dysuria; rectum hemorrhage; recurrence free survival; salvage brachytherapy; urinary tract fistula; high dose rate; pelvis abscess; patient-reported outcome; low dose rate; time to treatment; very elderly; human; male; priority journal; article; recurrent prostate cancer; urethra stenosis
Journal Title: Brachytherapy
Volume: 16
Issue: 6
ISSN: 1538-4721
Publisher: Elsevier Science, Inc.  
Date Published: 2017-11-01
Start Page: 1091
End Page: 1098
Language: English
DOI: 10.1016/j.brachy.2017.07.013
PROVIDER: scopus
PUBMED: 28838648
DOI/URL:
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Michael J Zelefsky
    624 Zelefsky
  2. Weiji Shi
    115 Shi
  3. Yoshiya Yamada
    359 Yamada
  4. Laszlo Voros
    13 Voros
  5. Gilad N Cohen
    132 Cohen
  6. Marisa A Kollmeier
    146 Kollmeier
  7. Xin Pei
    98 Pei
  8. Sean Matthew McBride
    111 McBride
  9. Mary   Lin
    4 Lin
  10. Amandeep Singh Taggar
    15 Taggar