Salvage radical prostatectomy for brachytherapy failure: preliminary results

• Published in: Progrès en urologie (Paris) Vol. 24; no. 5; p. 266
• Main Authors: Saeedi, Y, Pop, M, Jacqmin, D
• Format: Journal Article
• Language: French
• Published: France 01.04.2014
• Subjects: Adult; Aged; Brachytherapy - adverse effects; Feasibility Studies; Humans; Lymph Node Excision; Male; Middle Aged; Neoplasm Recurrence, Local - surgery; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Salvage Therapy; Treatment Failure; Échec de curiethérapie; Prostatectomy; Prostatectomie; Brachytherapy failure
• ISSN: 1166-7087
• DOI: 10.1016/j.purol.2013.08.314

Analysis of preliminary results in six patients operated by second-line (salvage) radical prostatectomy for local recurrence after low-dose brachytherapy. Since January 2009, six patients had an open salvage radical prostatectomy with a lymph node dissection and without neurovascular bundles preservation for a low-dose I125 brachytherapy failure. Local recurrence was confirmed by trans-rectal biopsy or TURP. All the patients had PSA increase or lower urinary tract symptoms. Bone scan and pelvis MRI were performed to detect a locally advanced disease, a lymph node involvement or the presence of bone metastasis. Pathology reports and PSA level at 1, 3, 6 and 12 months were analyzed. Salvage radical prostatectomy with lymph node dissection was performed in all patients without major complications. The PSA level was below 0.1 ng/mL in five out of six patients at 1 and 3 months. The only case of persistent PSA is treated by androgen deprivation in a pT3b N1 patient. Salvage radical prostatectomy after brachytherapy failure was feasible with a limited perioperative morbidity. This second-line curative treatment in a selected group of patients should be kept in mind. Our early results looked promising.