Radiation Oncology/Prostate/Recurrence after RT
From Wikibooks, open books for an open world
This page may need to be |
Front Page: Radiation Oncology | RTOG Trials | Randomized Trials |
|
|
Prostate: Main Page | Prostate Overview | Screening and Prevention | Workup | Natural History | External Beam RT | IMRT | Androgen Suppression Therapy | Brachytherapy | Protons | Prostatectomy | Adjuvant RT after Prostatectomy | Salvage RT | Chemotherapy | Localized prostate cancer | Node Positive | Advanced disease | Recurrence after RT | Cryotherapy | RTOG Prostate Trials | Randomized Evidence |
|
Salvage treatments for biochemical failure after definitive radiotherapy.
Contents |
[edit] Androgen ablation
Intermittent androgen ablation:
- Canadian trial - phase II
- PMID 16783817, 2006 — "Final results of the Canadian prospective phase II trial of intermittent androgen suppression for men in biochemical recurrence after radiotherapy for locally advanced prostate cancer: clinical parameters." Bruchovsky N et al. Cancer. 2006 Jul 15;107(2):389-95.
- 103 pts. Each cycle consisted of cyproterone acetate (CA) x 4 wks then Lupron plus CA for a total of 36 wks.
- Median f/u 4.2 yrs. Time off treatment averaged 53% of total cycle time.
[edit] Brachytherapy
- U.Wisconsin, 2007 (Review) PMID 17685384 -- "Management of prostate cancer recurrences after radiation therapy-brachytherapy as a salvage option." (Allen GW, Cancer. 2007 Oct 1;110(7):1405-16.)
- Review. Summarizes treatment of 226 pts reported in literature, including 12 pts from this institution not previously reported.
- Wisconsin experience: 12 pts, treated with brachy (I or Pd) + 3 mo neoadjuvant AA. Median f/u of 45 months after implant.
- Conclusion: salvage brachytherapy success rates are likely similar to salvage with surgery or cryotherapy.
HDR:
- UCSF (1998-2005)
- PMID 17197119, 2006 — "Feasibility of High-Dose-Rate Brachytherapy Salvage for Local Prostate Cancer Recurrence After Radiotherapy: The University of California-San Francisco Experience." Lee B et al. Int J Radiat Oncol Biol Phys. 2006 Dec 28.
- 21 pts. 36 Gy in 6 fractions.
- Conclusion: "feasible and effective"
[edit] Prostatectomy
Salvage Prostatectomy:
- Memorial Sloan-Kettering
- PMID 12756084, 2003 — "Salvage radical prostatectomy for recurrence of prostate cancer after radiation therapy." Eastham et al. Curr Urol Rep. 2003 June.
- Incontinence rates are similar to incontinence rates after up front prostatectomy
- Note: Most other series report higher incontinence rates in the range of 50%
- UCSF, 2001 (Review) PMID 11590813 -- "Salvage radical prostatectomy." (Shekarriz B, Urol Clin North Am. 2001 Aug;28(3):545-53.)
- Review.
- Baylor, 1995 PMID 7526002 -- "Salvage radical prostatectomy: outcome measured by serum prostate specific antigen levels." (Rogers E, J Urol. 1995 Jan;153(1):104-10.)
- 40 pts.
- pT3 or pN+ in 54% (more likely if PSA > 10).
- Mean 39 months f/u. 2 pts died from PCA, 5 developed DM; none had local recurrence. 5-yr PSA control 55%. (more likely if pre-surgery PSA < 10). In pts with pathologically localized disease (minimal T3), 82% had PSA control.
- Toxicity: 15% rectal injury (colostomy - 2 pts). Persistent urinary incontinence 58% (corrected with artificial sphincter in 9 of 18).
- Conclusion: salvage prostatectomy provides excellent control of recurrence cancer; best performed before PSA increases greater than 10-20.
[edit] Cryotherapy
- UK, 2007 (2000-5) PMID 17662081 -- "Salvage cryotherapy for recurrent prostate cancer after radiation failure: a prospective case series of the first 100 patients." (Ismail M, BJU Int. 2007 Oct;100(4):760-4. )
- 100 pts. Mean f/u 33 mo. 5-yr bRFS 73% (low risk pts), 45% (int), 11% (high)
- Toxicity: incontinence 13%, erectile dysfunction 86%, recto-urethral fistula 1%.
- Conclusion: salvage cryo is safe and effective
