Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2019

Abstract number 4

Salvage High Dose Brachytherapy at the Bristol Cancer Institute – Experience and Challenges 

Masson S, Closier P, Humphrey P, Bamisaye F, Brown A, Bahl A 
Bristol Haematology and Oncology Centre, Bristol 

Introduction: High dose rate salvage brachytherapy (HDRSB) is a minimally invasive treatment for locally recurrent prostate cancer following external beam radiotherapy (EBRT), particularly where prostatectomy is not appropriate in light of surgical morbidity (major complications in up to 35%1). 

Alternative management is ultimately palliative; however identifying those patients most likely to benefit from salvage procedures remains challenging. We describe our experience and highlight these issues from the first 5 HDRSB patients treated in Bristol. 

Methods: All patients had biopsy proven recurrent prostatic adenocarcinoma following Prostate Specific Antigen (PSA) relapse after prior EBRT. All underwent staging using various modalities (Computed tomography, Technetium bone scan, Choline Positron Emission Tomography, whole body Magnetic Resonance Imaging).

Brachytherapy catheters were placed under spinal anaesthesia using a transperineal template approach and transrectal ultrasound guidance, taking care to avoid the rectal interface. 19Gy was delivered to the whole prostate with no focal boost. Following treatment, PSA and toxicity data were recorded using standardised questionnaires. 

Results: There were no immediate complications from HDRSB. 1/5 (20%) required re-catheterisation on day 2. 5/5 (100%) experienced increased urinary frequency and urgency, 2/5 (40%) had residual grade 1 urinary toxicity at 1 year, and 2/5 (40%) reported late GI toxicity (at 2 years and 1 year respectively). 2/5 (40%) reported sexual dysfunction following HDR brachytherapy. 

Reduction in PSA was observed in 4/5 patients (80%); during follow up 2/5 (40%) have developed metastatic disease, 1/5 (20%) is awaiting restaging for PSA relapse, 1/5 (20%) is receiving ADT for PSA relapse, and 1/5 (20%) has a stable low PSA. 

Conclusion: HDRSB is technically feasible, with acceptable toxicity. A substantial proportion of patients have subsequently relapsed, which in part relates to difficulties with accurate staging in this group. Further work will include standardisation of staging, the use of rectal spacers and focal tumour HDRSB. 

Reference 

1. Tisseverasinghe S, Crook J. The role of salvage brachytherapy for local relapse after external beam radiotherapy for prostate cancer. Transl Androl Urol. 2018 Jun; 7(3): 414–435.