Salvage HDR brachytherapy for prostate cancer: a high-volume center experience on 100 consecutive patients.

AIM: This study aims to evaluate the safety and efficacy of salvage HDR brachytherapy in patients who have undergone a thorough diagnostic process. MATERIALS AND METHODS: 100 prostate cancer patients - locally relapsed after previous radiotherapy - were treated with salvage HDR brachytherapy to a total dose of 24 Gy. Before treatment, the patients underwent PET imaging, prostate MRI, and prostate biopsies to confirm local relapse and exclude systemic disease. Concomitant ADT was applied in 69 patients. Toxicity and efficacy data were collected as a patient chart review. Toxicity was graded using Common Terminology Criteria for Adverse Events (CTCAE 5.0). RESULTS: The 3-year bDFS and OS were 74% (confidence interval [CI] 95%: 60-87%) and 93% (CI 95%: 84-100%), respectively. Acute Grade 1-2 genitourinary toxicity was observed in 70 patients, 58 patients with Grade 1 and 12 patients with Grade 2, respectively. Acute Grade 1 gastrointestinal toxicity was observed in 8 patients. CONCLUSIONS: This retrospective study shows that salvage HDR brachytherapy is a well-tolerated and effective treatment for histologically proven, local radio-recurrent disease.

Multimodal Primary Treatment of Metastatic Prostate Cancer with Androgen Deprivation and Radiation.

AIM: We combined anti-androgen therapy with radiotherapy in a first-line setting for metastatic prostate cancer aiming to cause maximal cancer-cell death to delay the emergence of castration-resistant disease. MATERIALS AND METHODS: In this non-randomized retrospective series of 46 patients, the initial median prostate-specific antigen (PSA) was 98.5 µg/l (range=6.7-15,500), median Gleason score 9 and most men had at least T3N1M1 disease. All patients received luteinizing hormone releasing hormone analog or degarelix with bicalutamide. If PSA remained above 1 µg/l, docetaxel was initiated. At PSA nadir, all patients received radical radiotherapy of the prostate. RESULTS: The median follow-up time was 4.38 years (range=0.36-11.24). Most radiotherapy-related adverse events were grade 1 and transient. There were no grade 4 events. Overall survival (OS) at 5 years was 81.3%. CONCLUSION: The feasibility and safety of aggressive multimodality treatment were good resulting in an excellent median OS of 8.35 years.