Abstract
BackgroundTo report the efficacy and safety of salvage brachytherapy for seminal vesicle recurrence after initial brachytherapy in a patient with prostate cancer. As far as we know, this is a first report of salvage brachytherapy for seminal vesicle recurrence in Japan.Case presentationA 70-year-old Japanese man with low-risk prostate cancer received low-dose-rate brachytherapy. Forty-two months after the seed implantation, he showed biochemical recurrence based on the nadir + 2 ng/mL definition. The prostate specific antigen (PSA) level was 5.11 ng/mL at 58 months after seed implantation. A saturation biopsy of the prostate showed no recurrence. Systemic screening also showed no distant metastases. However, T2-weighted magnetic resonance imaging (MRI) demonstrated a low intensity area at the base of the right seminal vesicle, which was strongly suggestive of recurrence. Sixty months after the initial therapy, a seminal vesicle biopsy confirmed recurrence with a Gleason score of 4 + 3 before salvage brachytherapy was performed. The prescribed dose was 145 Gy, the same as the dose of the initial therapy. One month later, the PSA level had rapidly declined to 0.898 ng/mL without androgen deprivation therapy. Ten months after the salvage brachytherapy, the PSA level reached 0.078 ng/mL. No adverse events were seen during the follow-up period.ConclusionsWe experienced a patient who was successfully treated with salvage brachytherapy for seminal vesicle recurrence. Salvage brachytherapy is one of the promising therapeutic options for recurrence after initial brachytherapy.
Highlights
To report the efficacy and safety of salvage brachytherapy for seminal vesicle recurrence after initial brachytherapy in a patient with prostate cancer
We experienced a patient who was successfully treated with salvage brachytherapy for seminal vesicle recurrence
Several salvage therapeutic options including radical prostatectomy, radiation therapy and androgen deprivation therapy can be considered for patients who show seminal vesicle recurrence after prostate brachytherapy
Summary
Several salvage therapeutic options including radical prostatectomy, radiation therapy and androgen deprivation therapy can be considered for patients who show seminal vesicle recurrence after prostate brachytherapy. Case presentation A 70-year-old Japanese man underwent a medical checkup in March 2005, which showed an abnormal prostate specific antigen (PSA) value (4.8 ng/mL), and he consulted a urologist. Seminal vesicle biopsy was performed and the histological findings showed an adenocarcinoma with a Gleason score of 4 + 3 at the base of the right seminal vesicle. Regarding dosimetric parameters using CT images 1 month after salvage brachytherapy, seminal vesicle D90 was 280 Gy, seminal vesicle V100 was 100%, prostate D90 was 206.4 Gy, prostate V100 was 99.2%, the R100 was 0.26 mL, and the minimal dose (Gy) received by 30% of the urethra (UD30) was 285.7 Gy. The treatment time was 69 minutes. No adverse events were seen during the follow-up period
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