Local Recurrence Of Prostate Cancer Research Articles

Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer

To retrospectively evaluate external beam reirradiation (re-EBRT) delivered to the prostate/prostatic bed for local recurrence, after radical or adjuvant/salvage radiotherapy (RT). 32 patients received re-EBRT between February 2008 and October 2013. All patients had clinical/radiological local relapse in the prostate or prostatic bed and no distant metastasis. re-EBRT was delivered with selective RT technologies [stereotactic RT including CyberKnife(TM) (Accuray, Sunnyvale, CA); image-guidance and intensity-modulated RT etc.]. Toxicity was evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Biochemical control was assessed according to the Phoenix definition (NADIR + 2 ng ml(-1)). Acute urinary toxicity: G0, 24 patients; G1, 6 patients; G2, 2 patients. Acute rectal toxicity: G0, 28 patients; G1, 2 patients; and G2, 1 patient. Late urinary toxicity (evaluated in 30 cases): G0, 23 patients; G1, 6 patients; G2, 1 patient. Late renal toxicity: G0, 25 patients; G1, 5 patients. A mean follow-up of 21.3 months after re-EBRT showed that 13 patients were free of cancer, 3 were alive with biochemical relapse and 12 patients were alive with clinically evident disease. Four patients had died: two of disease progression and two of other causes. re-EBRT using modern technology is a feasible approach for local prostate cancer recurrence offering 2-year tumour control in about half of the patients. Toxicity of re-EBRT is low. Future studies are needed to identify the patients who would benefit most from this treatment. Our series, based on experience in one hospital alone, shows that re-EBRT for local relapse of prostate cancer is feasible and offers a 2-year cure in about half of the patients.

Post-treatment imaging—a desperate need for solid evidence

Many imaging techniques are currently used for detection of local or distant prostate cancer recurrences after primary treatment. A new retrospective registry study raises concerns about the pertinence of imaging test use after primary prostate cancer treatment. These findings emphasize the need for consensual guidelines on imaging in this setting.

The use of ultrasound contrast to evaluation the effectiveness of superselective embolization of arteries prostate of benign hyperplasia

The article presents the first Russian and international experience in the application of ultrasound contrast to evaluation the effectiveness of superselective embolization of arteries prostate benign hyperplasia her. Thoroughly describes the methodology of the arteries embolization prostate hyperplasia her. Given a clear algorithm and the necessary tools in this type of operations. Presented rationale for the use of microspheres Embozene as the most innovative embolization material. These microspheres exhibit shape memory, which allows them to shrink to 35 % and immediately recover its original volume after the release of the microcatheter. Studies have shown that the microspheres Embozene retain its original volume is not fragmented, which is a very important fact for the target artery embolization and radical prostate. Attentive readership presents the rationale and mechanical properties of ultrasound contrast, which is only selectively within the lumen of blood vessels and eliminates early relapse of prostate adenoma after embolization her arteries in its application. This area will allow the use of ultrasound contrast followed by researchers to determine the nature of the blood supply to the prostate and its changes after embolization of the arteries of the prostate. The article presents the clinical and uroflowmetry results of patients who underwent embolization. Denotes the vector of this technology in the elimination of the continued growth of the local and local recurrence of prostate cancer.

EP-1234: Hypofractionated radiotherapy in local recurrent prostate cancer after EBRT

EP-1234: Hypofractionated radiotherapy in local recurrent prostate cancer after EBRT

PO-0712: Role of 3T multiparametric MRI in the detection of local recurrent prostate cancer after radical prostatectomy

PO-0712: Role of 3T multiparametric MRI in the detection of local recurrent prostate cancer after radical prostatectomy

Role of 3T multiparametric MRI in the detection of local recurrent prostate cancer after radical prostatectomy

Role of 3T multiparametric MRI in the detection of local recurrent prostate cancer after radical prostatectomy

Metabolic syndrome, dyslipidemia and prostate cancer recurrence after primary surgery or radiation in a veterans cohort.

Metabolic syndrome (MetS) has been hypothesized to be associated with cancer, including prostate cancer (PCa), but the relationship is not well characterized. We analyze the relationship between MetS features and localized PCa recurrence after treatment. Men having primary treatment for localized PCa were included from a multi-site regional veteran network. Recurrence was defined as nadir PSA +2 ng ml(-1) (radiation) or PSA⩾0.2 ng ml(-1) (prostatectomy). MetS was based on consensus professional society guidelines from the American Heart Association and International Diabetes Federation (three of: hypertension >130/85 mm Hg, fasting blood glucose ⩾100 mg dl(-1), waist circumference >102 cm, high-density lipoprotein <40 mg dl(-1), triglycerides ⩾150 mg dl(-1)). Closely related abnormality in low-density lipoprotein (LDL; >130 mg dl(-1)) was also examined. Analysis of PCa recurrence risk included multivariable Cox proportional hazards regression with propensity adjustment. Of the 1706 eligible men, 279 experienced recurrence over a median follow-up period of 41 months (range 1-120 months). Adjustment variables associated with PCa recurrence included: index PSA, Gleason, and tumor stage. Independent variables of interest associated with PCa recurrence were hyperglycemia and elevated LDL. Elevated LDL was associated with PCa recurrence (multivariable hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.03, 1.74; propensity adjusted HR 1.33, 95% CI 1.03, 1.72). There was also an association between impaired fasting glucose and PCa recurrence in (multivariable HR 1.54, 95% CI 1.10, 2.15; propensity adjusted HR 1.41, 95% CI 1.01, 1.95). MetS was not associated with PCa recurrence (multivariable: HR 0.96, 95% CI 0.61, 1.50; propensity adjusted HR 1.04, 95% CI 0.67, 1.62). PCa recurrence is not associated with MetS but is associated with elevated LDL and impaired fasting glucose. If confirmed, these data may help provide modifiable targets in preventing recurrence of PCa.

Future role of ultrasound and MR imaging in prostate cancer: Editorial Comment on: T. Szopinski, A. Nowicki, F. Zaťura, T. Gołąbek and P. Chłosta Novel trends in transrectal ultrasound imaging of prostate gland carcinoma.

In response to the article of Szopinski et al.(1) we want to compliment the authors for a very thorough and sound review article. The authors listed the most significant developments and trends in prostate ultrasound, and mentioned the increasing role of MRI in prostate cancer diagnosis and staging. In our opinion, despite the impressive recent developments of Ultrasound we see MRI already presently and even more in the future as the primary imaging modality for detection, staging, active surveillance, and local recurrence of prostate cancer(2). Yet, Ultrasound will maintain its established role in real time image guidance during transrectal (TRUS) prostate biopsies. Otherwise, Ultrasound cannot match the image quality and accuracy of MRI. Besides the superior soft tissue contrast and high resolution of MR images, it offers a comprehensive tissue assessment: anatomic/topographical with T2-W images for example, pathophysiologic (tissue/tumor, perfusion/diffusion) with dynamic contrast enhanced MR and diffusion weighted imaging (DWI), and metabolic/molecular with Spectroscopy. Besides being relatively operator independent and reproducible, MR imaging has been proven to have superior sensitivity, specificity, and accuracy in detection and staging of prostate cancer(3, 4). Especially the improvement of diffusion weighted imaging (DWI and DTI), and Spectroscopy make MRI the most powerful and comprehensive imaging modality for prostate cancer. This is reflected in the increasing number of referrals by urologists and other clinicians over the last 10 years, with a +7% increase in prostate MRI exams per year in the US over the last 4 years (making prostate MR the fastest growing MR exam). In the age of widely accessible internet and public medical knowledge about proper management of disease, well informed patients more and more themselves request prostate MRI, especially before repeat biopsies. The increasing demand of prostate MR results in decrease of costs and will consequently further increase the numbers of referrals to MR. Although the costs for MR will further decline, MR will never be as inexpensive as ultrasound. Therefore, we see the role of ultrasound in TRUS guided biopsies, with MRI/ US image fusion, as the future standard of care. MR-guided biopsies will be reserved for patients with repeat negative biopsies, since those are compared to TRUS biopsies, costly and time consuming. Fig. 1 62-year-old patient, PSA = 9; bilateral several positive biopsy cores; Gleason score = 7; with clinically und sonographically suspected extraglandular extension (ECE) of a large bilateral prostate cancer. MRI was ordered by the urologist to confirm ECE. ... Finally, promoted by the latest controversial discussions about PSA and prostatectomies, more and more patients with small and low Gleason score cancers choose active surveillance rather than aggressive treatment. Currently, there are about 30% of the patients (in our institution and US national average) on active surveillance. In this particular patient cohort, MRI is the only clinical tool to meaningfully observe the cancer over time: MRI can assess for small yet clinically significant interval changes of the cancer over time, which would necessitate intervention (e.g. surgery or radiation therapy), can guide a targeted repeat biopsy, and consequently can facilitate appropriate treatment decision. In the coming years, prostate MRI will be state-of-the-art and the routine clinical care for prostate cancer pre- and post-treatment assessment and management, while ultrasound will be essential for MR-US fusion biopsies.

The Effect of Androgen Deprivation Therapy Before Salvage Whole-gland Cryoablation After Primary Radiation Failure in Prostate Cancer Treatment

To define the effects of androgen deprivation therapy (ADT) used prior to salvage cryoablation (SC) for the treatment of recurrent localized prostate cancer after radiation. Patients from the Cryo On-Line Database registry undergoing SC after radiation failure were divided according to whether they had previously received or not received ADT. Baseline characteristics including demographics and presalvage cancer risk were compared. Biochemical progression-free survival (bPFS) as defined by the Phoenix criteria was compared between the 2 groups as a whole and also in D'Amico risk-stratified subgroups. In addition, postsurgical complications such as urinary fistula, retention, incontinence, and erectile dysfunction were compared. Two groups consisting of 254 and 486 patients with and without pre-SC ADT were analyzed. The patients who received ADT were younger (P = .003) and had higher presalvage D'Amico risks (P <.001). The 5-year bPFS was 63.8% and 39.3% for the hormone-naïve and the pre-SC ADT patients, respectively (P <.001). On subgroup analysis, the difference in 5-year bPFS was significant only for patients with a high D'Amico cancer risk (54.3% vs 30.5%; P = .013). On multivariate analysis, presalvage prostate-specific antigen (hazard ratio [HR], 1.7), Gleason score ≥ 8 (HR, 2.5), and use of pre-SC ADT (HR, 1.7) correlated with biochemical recurrence. Additionally, patients receiving pre-SC ADT experienced less urinary retention (P = .001) and incontinence (P = .008) but were more likely to be impotent (P = .010). Patients receiving ADT before SC, especially those with high-risk prostate cancer, had worse 5-year bPFS. Added caution is needed when selecting patients having previously received ADT for salvage cryotherapy.

First experience of salvage HDR brachytherapy after prostate cancer radiotherapy

Introduction. Prostate cancer (PC) is the most common oncologic disease among men. The number of patients with recurrent PC after primary radiotherapy is increasing, unfortunately, criteria for the choice among different treatment methods for these patients have not been defined yet. Salvage treatment options include prostatectomy, brachytherapy (BT), cryotherapy, thermoablation, and high frequency ultrasound. The lack of long-term evaluation of the toxicity and influence on the survival of patients after salvage high-dose-rate (HDR) BT is an important problem when considering this treatment option. In this study we have analyzed the treatment results of twelve patients who were diagnosed with local recurrent prostate cancer after primary radiotherapy and then treated with HDR BT. Materials and methods. Patients were treated with salvage HDR BT between January 2013 and February 2014 at the Institute of Oncology, Vilnius University Results. Average age of the patients at the time of salvage treatment was 67.5 years (min 54 years, max 76 years). The PSA value at the salvage treatment was from 2.06 ng/ml to 9.20 ng/ml. The time from the initial diagnosis till the salvage treatment was from 33 months to 134 months. All 24 procedures were successful and without any early complications. Conclusions. HDR BT is a presumable and safe treatment option for local prostate cancer recurrence after primary radiotherapy. Prospective clinical trial is initiated to evaluate survival, long-term toxicity and predictive value of different biomarkers.

Role for (11)C-choline PET in active surveillance of prostate cancer.

Active surveillance (AS) is an increasingly popular management strategy for men diagnosed with low-risk indolent prostate cancer. Current tests (prostate-specific antigen [PSA], clinical staging, and prostate biopsies) to monitor indolent disease lack accuracy. (11)C-choline positron emission tomography (PET) has excellent detection rates in local and distant recurrence of prostate cancer. We examine (11)C-choline PET for identifying aggressive prostate cancer warranting treatment in the AS setting. In total, 24 patients on AS had clinical assessment and PSA testing every 6 months and (11)C-choline PET and prostate biopsies annually. The sensitivity and specificity to identify prostate cancer and progressive disease (PD) were calculated for each (11)C-choline PET scan. In total, 62 biopsy-paired, serial (11)C-choline PET scans were analyzed using a series of standard uptake value-maximum (SUVmax) cut-off thresholds. During follow-up (mean 25.3 months), 11 of the 24 low-risk prostate cancer patients developed PD and received definitive treatment. The prostate cancer detection rate with (11)C-choline PET had moderate sensitivity (72.1%), but low specificity (45.0%). PD prediction from baseline (11)C-choline PET had satisfactory sensitivity (81.8%), but low specificity (38.5%). The addition of clinical parameters to the baseline (11)C-choline PET improved specificity (69.2%), with a slight reduction in sensitivity (72.7%) for PD prediction. Addition of (11)C-choline PET imaging during AS may help to identify aggressive disease earlier than traditional methods. However, (11)C-choline PET alone has low specificity due to overlap of SUV values with benign pathologies. Triaging low-risk prostate cancer patients into AS versus therapy will require further optimization of PET protocols or consideration of alternative strategies (i.e., magnetic resonance imaging, biomarkers).

Role of 3T multiparametric magnetic resonance imaging without endorectal coil in the detection of local recurrent prostate cancer after radical prostatectomy: the radiation oncology point of view

Objective. The aims of this study were to evaluate the role of 3 tesla multiparametric magnetic resonance imaging (3TmMRI) without endorectal coil in the detection of radiographic local recurrences (rLRs) in a contemporary cohort of patients with prostate cancer who presented with biochemical recurrence after radical prostatectomy (RP) with low prostate-specific antigen (PSA) levels, and to identify clinical parameters associated with the 3TmMRI findings. Materials and methods. Between 2009 and 2013, 57 patients with biochemical recurrence of prostate cancer after RP who were considered for salvage radiation therapy (SRT) were included. 3TmMRI with T2-weighted imaging, diffusion weighted imaging (DWI) and dynamic contrast-enhanced imaging without endorectal coil was carried out in all patients before treatment. Results. In 14 out of 57 patients (24.56%) local recurrence was detected through 3TmMRI. Median pre-SRT PSA was 0.40 ng/ml (interquartile range 0.30–2.05 ng/ml). The recurrence was perianastomotic in eight out of 14 patients (57.14%) and retrovesical in six out of 14 patients (42.86%). The median size of the local recurrence was 15.2 mm (range 8.0–46.0 mm). The probability of rLR was significantly higher in patients with PSA levels above 0.5 ng/ml [adjusted odds ratio (OR) 6.25, 95% confidence interval (CI) 1.27–30.79, p = 0.02] or PSA doubling time (PSADT) over 14 months (adjusted OR 7.12, 95% CI 1.40–36.25, p = 0.01). Conclusions. This is the first study to find a significant relationship between the PSADT and the rLR through MRI. Patients with PSADT longer than 14 months or pre-SRT PSA above 0.5 ng/ml benefited most from 3TmMRI. Its routine use could have significant clinical implications for SRT.

Salvage Brachytherapy for Castration-Resistant and External Beam Radiotherapy-Resistant Local Recurrence 17 Years after Radical Prostatectomy.

A 47-year-old Japanese man was diagnosed with prostate cancer in February 1995 (Initial PSA 77.2 ng/mL, GS3 + 4, cT3N0M0). He underwent radical prostatectomy after androgen deprivation therapy (ADT) in June 1995. Nine years after operation, he was diagnosed with local recurrence of prostate cancer and he received postoperative external beam radiation therapy (EBRT) (70 Gy). By May 2008, the PSA dropped to 0.33 ng/mL, and a CT scan showed that the mass had disappeared. On April 2012, the PSA once again rose to 3.1 ng/mL. CT scan and MRI revealed a mass in the prostatic bed. We diagnosed local recurrence of prostate cancer. We underwent salvage low-dose brachytherapy after obtaining informed consent. The prescribed dose of the salvage brachytherapy was 145 Gy to control the tumor considering the hormone resistant prostatic cancer and high-risk feature. PSA level rapidly decreased to 0.66 ng/mL by 6 months after seed implantation. No adverse events were seen during the follow-up period.

Salvage brachytherapy in combination with interstitial hyperthermia for locally recurrent prostate carcinoma following external beam radiation therapy: a prospective phase II study.

Optimal treatment for patients with only local prostate cancer recurrence after external beam radiation therapy (EBRT) failure remains unclear. Possible curative treatments are radical prostatectomy, cryosurgery, and brachytherapy. Several single institution series proved that high-dose-rate brachytherapy (HDRBT) and pulsed-dose-rate brachytherapy (PDRBT) are reasonable options for this group of patients with acceptable levels of genitourinary and gastrointestinal toxicity. A standard dose prescription and scheme have not been established yet, and the literature presents a wide range of fractionation protocols. Furthermore, hyperthermia has shown the potential to enhance the efficacy of re-irradiation.Consequently, a prospective trial is urgently needed to attain clear structured prospective data regarding the efficacy of salvage brachytherapy with adjuvant hyperthermia for locally recurrent prostate cancer. The purpose of this report is to introduce a new prospective phase II trial that would meet this need. The primary aim of this prospective phase II study combining Iridium-192 brachytherapy with interstitial hyperthermia (IHT) is to analyze toxicity of the combined treatment; a secondary aim is to define the efficacy (bNED, DFS, OS) of salvage brachytherapy. The dose prescribed to PTV will be 30 Gy in 3 fractions for HDRBT, and 60 Gy in 2 fractions for PDRBT. During IHT, the prostate will be heated to the range of 40–47°C for 60 minutes prior to brachytherapy dose delivery. The protocol plans for treatment of 77 patients.

Less advanced disease at initiation of salvage androgen deprivation therapy is associated with decreased mortality following biochemical failure post-salvage radiation therapy.

BackgroundThe optimal clinical context for initiation of salvage androgen deprivation therapy (SADT) following the biochemical recurrence of localized prostate cancer remains controversial. We chose to investigate if disease burden at time of SADT initiation is associated with clinical outcomes following biochemical failure (BF) post-salvage radiation therapy (SRT).MethodsMedical records of 575 patients receiving SRT at a single institution from 1986–2010 were retrospectively reviewed. Of 250 patients experiencing BF post-SRT, 172 had a calculable prostate-specific antigen doubling time (PSADT) prior to SADT initiation. These patients comprise the analyzed cohort and were divided into four groups based on characteristics at SADT initiation: those with PSADTs >3 months without distant metastasis (DM) (group 1 [less advanced disease], n = 62), those with PSADTs <3 months without DM (group 2 [more advanced disease], n = 28), those with DM (group 3 [more advanced disease], n = 32), and those not receiving SADT during follow-up (group 4, n = 50). Endpoints included prostate cancer-specific mortality (PCSM) and overall mortality (OM). Kaplan-Meier methods were used to estimate survival, and Cox proportional hazards models were used for multivariate analysis.ResultsMedian follow-up post-SRT was 7.9 years. Patients starting SADT with more advanced disease were at significantly increased risk for PCSM (hazard ratio [HR]:2.8, 95% confidence interval [CI]: 1.4–5.6, p = 0.005) and OM (HR:1.9, 95% CI: 1.0–3.5, p = 0.04) compared to those receiving SADT with less advanced disease. PCSM and OM did not significantly differ between groups 1 and 4 or groups 2 and 3. Of note, patients in group 4 had very long PSADTs (median = 27.0 months) that were significantly longer than those of group 1 (median = 6.0 months) (p < 0.001). Multivariate analysis including groups 1–3 found a pre-SADT PSADT <3 months to be the most significant predictor of PCSM (HR:4.2, 95% CI: 1.6–11.1, p = 0.004) and the only significant predictor of OM (HR:2.9, 95% CI: 1.3–6.7, p = 0.01).ConclusionsLess advanced disease at initiation of SADT is associated with decreased PCSM and OM following BF post-SRT; however, observation may be reasonable for patients with very long PSADTs. A PSADT <3 months prior to SADT initiation significantly predicts an increased risk of PCSM and OM in this patient demographic.

P054 Diagnostics of local recurrence of prostate cancer after radical prostatectomy: Native endorectal MRI and endorectal DCE-MRI

P054 Diagnostics of local recurrence of prostate cancer after radical prostatectomy: Native endorectal MRI and endorectal DCE-MRI

P074 Salvage Stereotactic Body Radiation Therapy (SBRT) for prostate cancer local recurrence after radical prostatectomy

P074 Salvage Stereotactic Body Radiation Therapy (SBRT) for prostate cancer local recurrence after radical prostatectomy

Traitements de rattrapage par HIFU après radiothérapie première et par radiothérapie après HIFU première dans la récidive locale du cancer de prostate : analyse rétrospective de la toxicité

To evaluate the toxicity of therapeutic sequences High Intensity Focused Ultrasound (HIFU)-salvage radiotherapy (HIFU-RT) or radiotherapy-salvage HIFU (RT-HIFU) in case of locally recurrent prostate cancer. Nineteen patients had a local recurrence of prostate cancer. Among them, 10 patients were treated by HIFU-RT and 9 patients by RT- HIFU (4 by external beam radiotherapy [EBR] and 5 by brachytherapy [BRACHY]). Urinary side effects were assessed using CTCAE v4. At the time of the initial management, the median age was 66.5 years (53-72), the median PSA was 10.8ng/mL (3.4-50) and the median initial Gleason score was 6.3 (5-8). Median follow-up after salvage treatment was 46.3 months (2-108). Thirty percent of the patients in the HIFU-RT group and 33.3 % of the patients in the RT-HIFU group, all belonging to the sub-group BRACHY-HIFU, had urinary complication greater than or equal to grade 2. Among all the patients, only 1 had grade 1 gastrointestinal toxicity. BRACHY-HIFU sequence seems to be purveyor of many significant urinary side effects. A larger database is needed to confirm this conclusion.

Imaging Evaluation of Recurrence in Treated Prostate Cancer

: Prostate cancer is the most common cancer in men and although most prostate cancers are slow growing but aggressive prostate cancers cases are seen too. Prevalence of prostate cancer vary widely across the world, it is more common in the developed countries. It is the second leading cause of cancer-related death in men in the United States and the sixth cause of cancer-related death globally in the world. Many cases of prostate cancer remain subclinical and never have symptoms until late progressive stages of the disease. About 85% of patients diagnosed with prostate cancer have localized disease and could be treated by definitive radiation therapy or radical prostatectomy. In 3050% of patients who had radical prostatectomy, PSA relapse happens at 5 years. Diagnosis and treatment of patients with PSA relapse are difficult. Detection of local recurrence of prostate cancer is important because it could be treated by local radiation therapy. Local treatment of local recurrence of prostate cancer have higher rate of complications in comparison to treatment of primary prostate cancer, hence, accurate detection of local recurrence and excluding distant metastasis is important. Distant metastasis is treated by hormone therapy. Imaging studies play an important role in detection of local recurrence of prostate cancer and its differentiation with distant metastasis. The main imaging studies that are used for evaluation of patients after radical prostatectomy are transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI). The patients with local recurrence of prostate cancer could be divided to three groups based on imaging studies. 1- Patients who have a mass lesion in surgical bed that is detectable by both MRI and TRUS. TRUS is useful for obtaining biopsy from these mass lesions. 2- Patients who have residual prostate tissue detectable by both MRI and TRUS. The residual tissue may be tumoral and responsible for local recurrence or may be non-tumoral. MRI functional studies including dynamic contrast study, diffusion weighted imaging (DWI) and MR spectroscopy (MRS) is able to confirm presence of tumoral tissue within the prostate glands remnant. Differentiation of tumoral and non-tumoral prostate remnant is not possible by means of TRUS but TRUS is useful for doing biopsy from the prostate remnant. 3- There is no mass lesion in surgical bed and anastomotic site and surrounding tissues have normal appearance in both TRUS and conventional MRI but local tumor recurrence is detected by functional MR studies like abnormal early phase enhancement in surgical bed structures, restrictive pattern in DWI or rise in choline to creatine ratio in MRS. There is no role for TRUS in detection and management of this third group of patients. CT scan is not useful for evaluation of prostate gland itself but is beneficial for evaluation of lungs and abdominal organs and can detect skeletal metastasis.

HDR Brachytherapy for Treatment of Local Recurrent Prostate Cancer

To find place of HDR brachytherapy in the process of re-treatment for the patients with local recurrence of prostate cancer after primary radiotherapy or surgery + radiotherapy or brachytherapy. Mainly we were looking for coincidences between OS and DFS and PSA level, primary Gleason score, T stage and time between primary and secondary treatment. Between 2000 and 2012, 173 patients with recurrent prostate cancer were treated by HDR brachytherapy. In all cases only local recurrence was observed. All patients with extracapsular invasion or distant metastase were excluded. In all cases recurrence was proven by biopsy. Treatment scheme was based on 3 times 10Gy per fraction every 21 or 14 days. In all cases subarachnoideal aneasthesia was done. Needle implantation based on Template (Nucletron, an Elekta company) and dose calculation based on SWIFT program (Nucletron) Irradiation by Microselectron (Nucletron) was done. Mean time of observation was 72 mts (12-144) and OS was correlated with PSA level, Gleason score and T stage. OS was for 7 years 72% DFS 53%. Strong correlation for Gleason 6 was respectively 81% to 43% also for time from primary treatment <2 y and >2y was 35% to 84%. Rate of early and late site effects will be demonstrated. HDR brachytherapy as an option for recurrent prostate cancer seems be safe and may be preferable for secondary line prostate cancer treatment. A main qualification factor use to be Gleason score and time from primary treatment to relapse.