Stereotactic body radiation therapy salvage reirradiation of radiorecurrent prostatic carcinoma relapsed in the prostatic bed.

A 67-year-old man presented with a slow increase of prostate-specific antigen value after radical prostatectomy and postoperative radiotherapy for prostate cancer. The patient had received 3D conformal radiotherapy to a total dose of 66 Gy in 33 fractions of 2 Gy each on the prostatic bed. Three years later, a macroscopic local failure was diagnosed at the apical region. The patient could not receive androgenic deprivation therapy or other types of treatment owing to comorbid conditions. Thus, stereotactic body radiation therapy with helical image-guided tomotherapy was administered. The total dose was 30 Gy in 5 consecutive fractions of 6 Gy each to the site of the local failure. The treatment was preceded by a transperineal-guided injection of a self-absorbable hydrogel into the prostatic bed, between rectum and bladder, in order to preserve the rectal wall, which already had received significant doses from the first radiation course. Radiation therapy was well-tolerated. After a follow-up period of 6 months, the patient remains healthy, and there has been no further evidence of metastatic spread or recurrence.

Bioptic ultrasound-guided prostate remapping (fan shape) using grid software for brachytherapy.

A new transperineal ultrasound-guided prostate rebiopsy method is described. The method is performed using a fixed grid approach similar to the method that has been in use for some time for brachytherapy i n prostate cancer. The method adopts special cylindrical cutting needles to take cores of varying lengths and was found to be more time consuming (this is the main reason it is mostly used for rebiopsies). It nevertheless allowed more accurate ard systematic mapping of the prostate gland than the standard method of taking multiple biopsies by sector. Sending in each biopsy fragment for separate histological examination based on grid coordinates allowed the Anatomical Pathology laboratory to build up an ideal topographic reconstruction of the disease lesions detected. The approach offers the advantages of a repeatable biopsy plan that can be compared with previous biopsies, more accurate spatial localisation of diseased tissue and accurate information on distribution within the gland. The benefits are multifold and all extremely interesting both for the diagnosis and subsequent choice, evaluation and administration of therapeutic treatment--and also for the dynamic study of evolving cell changes and cell structure anomalies detectable in the prostate gland.