Salvage prostate brachytherapy for postradiation local failure

Abstract

For a long time, one drawback of both prostate external-beam radiotherapy (EBRT) and brachytherapy was linked to the risk of morbidity associated with any local salvage therapy such as radical prostatectomy. For this reason, some patients may choose primary radical prostatectomy, following which salvage local EBRT still remains a possible curative salvage option, as recommended by many urologists. Life-long androgen deprivation therapy (ADT) was the standard of care for patients with rising PSA levels after primary radiotherapy [1, 2]. However, ADT is associated with a number of toxicities, such as erectile dysfunction, decreased libido, gynecomastia, hot flashes, osteoporosis, and metabolic syndrome. An alternative that has recently emerged is intermittent life-long androgen deprivation, which in theory results in an improvement in quality of life compared to continuous androgen deprivation therapy, though this may not be the case [3-5]. However, all patients are doomed to progress to castrate-resistant prostate cancer and develop metastases, making this treatment palliative only.