Focal salvage low‐dose‐rate brachytherapy for recurrent prostate cancer based on magnetic resonance imaging/transrectal ultrasound fusion biopsy technique

Abstract

Objective To examine the effect of permanent salvage brachytherapy in prostate cancer patients suffering recurrence after three‐dimensional conformal external beam radiotherapy. Methods The ultra‐focal (target lesion alone), hemi‐lobe (within a hemi‐lobe) or focused whole‐gland (focusing on the lesion, but extending into the whole gland) pattern was selected based on the Gleason score for the targeted biopsy, the numbers of positive cores in the targeted and systematic biopsies, and the locations of the positive cores. Novel dosimetry criteria derived from three‐dimensional cancer mapping, which was based on targeted magnetic resonance imaging/transrectal ultrasound fusion biopsies, were used in these cases. Results Permanent salvage brachytherapy was carried out in 13 patients who suffered prostate‐specific antigen failure (prostate‐specific antigen 2.1–6.8 ng/mL; age range 57–75 years; Gleason score ≤7 [ n = 10], Gleason score ≥8 [ n = 2] and Gleason score not available [ n = 1]) since 2012. The targeted biopsy showed a single focus in three patients. The ultra‐focal, hemi‐lobe and focused whole‐gland patterns were chosen in three, five and five patients, respectively. During the follow‐up period (median duration 48 months), prostate‐specific antigen failure occurred in zero of three, one of five and three of five of the patients treated with the ultra‐focal, hemi‐lobe and focused whole‐gland patterns, respectively. The 4‐year biochemical recurrence‐free survival rate was 74%. No grade 3–4 adverse intestinal or urological events occurred. Conclusions Targeted fusion biopsy‐based three‐dimensional cancer mapping should be used for permanent salvage brachytherapy treatment planning to reduce the incidence of treatment‐related adverse events while maintaining good oncological outcomes.