Can brachytherapy be a reasonable salvage option for men with a local recurrence after the failure of initial radiotherapy for prostate cancer treatment? A recent review of the literature evaluated the use of radiation as a salvage option after the failure of local-only treatment with radiation. The results were mixed.
The researchers did a PubMed search from inception to June 2012.
They found eighteen separate studies which included a widely different patient populations, treatment methods, follow-up periods, and reporting.
They found only one phase II prospective study with no randomized controlled trials. Biochemical disease-free survival (bDFS) at four to 5 years ranged from 20 to 75 %. Patient selection may have influenced these varying rates since some studies with lower bDFS had higher risk populations.
Factors associated with improved bDFS included post-treatment prostate-specific antigen (PSA) nadir of <0.5 ng/mL, pre-salvage PSA <6, Gleason score ?7, and PSA doubling time (PSADT) >10 months.
Overall survival ranged from 54% to 94%, and disease-specific survival ranged from 74% to 100%. The crude rate of grade 3–4 genitourinary toxicities among all studies was 13 % (range 0–47 %), and the crude rate of grade 3–4 gastrointestinal toxicities was 5 % (range 0–20 %). Incontinence rates were low among reviewed studies at 4 % (range 0–29 %).
They concluded that the rates of toxicities, as in other salvage treatments, can be fairly high, and the likelihood of death from prostate recurrence variable.
They concluded that additional prospective studies are needed to better define the efficacy and toxicity of this treatment modality.
Stephen J. Ramey, David T. Marshall in World Journal of Urology (2012)
Joel T. Nowak, M.A., M.S.W.