Prostate high-dose-rate brachytherapy as salvage treatment of local failure after previous external or permanent seed irradiation for prostate cancer

Purpose To report our results in using high-dose-rate (HDR) brachytherapy for salvage of local-only failure, after either external beam radiation or permanent seed implant. Methods and materials The data from 7 patients treated with salvage HDR brachytherapy at our institution was retrospectively reviewed. Information was gathered from chart review and prostate HDR specific questionnaires completed at followup visits. Results All 7 patients had local-only failure defined by transrectal biopsy. Median followup is 58 months (range, 27–63), with a 71% disease-free survival rate; median survival has not yet been reached. Two patients died of metastatic disease. There have been no further local failures. There has been no Grade 3 or higher rectal injuries. Five patients (71%) developed symptomatic urethral strictures; two previous seed failures developed incontinence with urethral necrosis, salvaged by placement of artificial sphincter or continent catheter channel. These results compare favorably to reported results with salvage permanent seed brachytherapy, prostatectomy, and cryotherapy. Conclusions HDR brachytherapy as salvage of local-only failure after previous radiation has limited data reported to date. The disease control rates and complications of treatment compare very favorably with those reported using other modalities. This approach merits further investigation.