Androgen Deprivation Therapy for Salvage Treatment of PSA Only Recurrent Prostate Cancer After Interstitial High-Dose-Rate Brachytherapy for Early Stage Prostate Cancer: Median 6-Year Followup in 27 Patients

Abstract

Purpose: Salvage treatment of biochemical recurrence after radiation implant is a subject of considerable controversy. Management options include PSA surveillance, radical prostatectomy, cryosurgery, external radiation therapy (XRT), intensity modulated radiation therapy (IMRT), and androgen deprivation therapy (ADT). Complication risks after radical prostatectomy, cryosurgery, XRT and IMRT salvage can be significant. We present our results in 27 patients treated with ADT for biochemical recurrence after high-dose-rate (HDR) implant. Materials and Methods: Between 1997 and 2010, 317 patients with T1 and T2 localized prostate underwent TRUS guided interstitial implant, under spinal anesthetic or local anesthetic. There were no Gleason Score or PSA exclusions. No patient received XRT, IMRT, or initial ADT. Median Gleason Score was 7 (range: 4 to 10). Median PSA was 9.3 (2.7 to 39.8). At last followup, 36 patients had developed PSA only relapse. After a discussion of management options, 27 patients elected salvage treatment with intermittent ADT, starting with Casodex. All patients started Casodex 50 mg qd with PSA <10. Results: With a median followup of 72 months (range: 6 months to 132 months), the PSA control rate on Casodex or Lupron was 81.5% (22/27). Five of these patients have become refractory to Casodex, and were switched to Lupron. Three of these patients remain controlled on Lupron. One patient entered a clinical trial for Chemotherapy. Two patients have died from metastatic prostate cancer. Two patients developed bone metastases. Side effects have been acceptable. One patient sustained a myocardial infarction, and a 2nd suffered a fractured hip. Conclusions: With median 6-year followup, ADT appears to be a reasonable salvage option for patients experiencing a PSA only relapse after HDR implant.