Prostate Cancer

  • Marco van Vulpen
Part of the Medical Radiology book series (MEDRAD)


Salvage radiotherapy for locally recurrent prostate cancer after primary radiation is generally performed by brachytherapy. Only a limited amount of small studies has been performed, all retrospective. In these studies the rate of severe toxicity was high and outcome was disappointing, and therefore, salvage treatments are not popular. Furthermore, it is unclear whether salvage treatment will improve disease-specific or overall survival. Salvage currently can be considered in patients with a pathology proven local recurrence after an interval of at least 2–3 years after primary treatment, together with a limited and non-aggressive tumor presentation at time of salvage. Currently, experienced groups recommend at least equal doses to primary treatment to the entire prostate. Current developments in PET and MRI imaging give the possibility to localize the macroscopic recurrent tumor in the prostate. This enables future focal salvage techniques which can be expected to reduce severe toxicity rates.


Prostate Cancer Radical Prostatectomy Salvage Treatment Dynamic Contrast Enhance Magnetic Resonance Image Recurrent Prostate Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Agarwal PK, Sadetsky N, Konety BR, Resnick MI, Carroll PR (2008) Treatment failure after primary and salvage therapy for prostate cancer: likelihood, patterns of care, and outcomes. Cancer 112:307–314PubMedCrossRefGoogle Scholar
  2. Ahmed HU, Pendse D, Illing R et al (2007) Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract Oncol 4:632–642PubMedCrossRefGoogle Scholar
  3. Akyol F, Ozyigit G, Selek U et al (2005) PSA bouncing after short term androgen deprivation and 3D-conformal radiotherapy for localized prostate adenocarcinoma and the relationship with the kinetics of testosterone. Eur Urol 48:40–45PubMedCrossRefGoogle Scholar
  4. Bahn DK, Lee F, Silverman P et al (2003) Salvage cryosurgery for recurrent prostate cancer after radiation therapy: a seven-year follow-up. Clin Prostate Cancer 2:111–114PubMedCrossRefGoogle Scholar
  5. Barentsz JO, Fütterer JJ, Takahashi S (2007) Use of ultrasmall superparamagnetic iron oxide in lymph node MR imaging in prostate cancer patients. Eur J Radiol 63:369–372PubMedCrossRefGoogle Scholar
  6. Battermann JJ (2000) Feasibility of permanent implants for prostate cancer after previous radiotherapy in the true pelvis. Radiother Oncol 73:297–300CrossRefGoogle Scholar
  7. Beyer DC (1999) Permanent brachytherapy as salvage treatment for recurrent prostate cancer. Urology 54:880–883PubMedCrossRefGoogle Scholar
  8. Bianco FJ Jr, Scardino PT, Stephenson AJ et al (2005) Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy. Int J Radiat Oncol Biol Phys 62:448–453PubMedCrossRefGoogle Scholar
  9. Bostwick DG, Egbert BM, Fajardo LF (1982) Radiation injury of the normal and neoplastic prostate. Am J Surg Pathol 6:541–551PubMedCrossRefGoogle Scholar
  10. Brachman DG, Thomas T, Hilbe J, Beyer DC (2000) Failure-free survival following brachytherapy alone or external beam irradiation alone for T1–2 prostate tumors in 2222 patients: results from a single practice. Int J Radiat Oncol Biol Phys 48:111–117PubMedCrossRefGoogle Scholar
  11. Breeuwsma AJ, Pruim J, van den Bergh AC, Leliveld AM, Nijman RJ, Dierckx RA, de Jong IJ (2010) Detection of local, regional, and distant recurrence in patients with psa relapse after external-beam radiotherapy using (11)C-choline positron emission tomography. Int J Radiat Oncol Biol Phys 77:160–164PubMedCrossRefGoogle Scholar
  12. Buyyounouski MK, Hanlon AL, Eisenberg DF, Horwitz EM, Feigenberg SJ, Uzzo RG et al (2005) Defining biochemical failure after radiotherapy with and without androgen deprivation for prostate cancer. Int J Radiat Oncol Biol Phys 63:1455–1462PubMedCrossRefGoogle Scholar
  13. Cellini N, Morganti AG, Mattiucci GC et al (2002) Analysis of intraprostatic failures in patients treated with hormonal therapy and radiotherapy: implications for conformal therapy planning. Int J Radiat Oncol Biol Phys 53:595–599PubMedCrossRefGoogle Scholar
  14. Chin JL, Pautler SE, Mouraviev V et al (2001) Results of salvage cryoablation of the prostate after radiation: identifying predictors of treatment failure and complications. J Urol 165:1937–1941PubMedCrossRefGoogle Scholar
  15. Cox JD, Grignon DJ, Kaplan RS, Parsons JT, Schellhammer PF (1997) Consensus statement: guidelines for PSA following radiation therapy. American society for therapeutic radiology and oncology consensus panel. Int J Radiat Oncol Biol Phys 37:1035–1041CrossRefGoogle Scholar
  16. Crook J, Robertson S, Collin G et al (1993) Clinical relevance of trans-rectal ultrasound, biopsy, and serum prostate-specific antigen following external beam radiotherapy for carcinoma of the prostate. Int J Radiat Oncol Biol Phys 27:31–37PubMedCrossRefGoogle Scholar
  17. Crook JM, Perry GA, Robertson S et al (1995) Routine prostate biopsies following radiotherapy for prostate cancer: results for 226 patients. Urology 45:624–631PubMedCrossRefGoogle Scholar
  18. Crook J, Bahadur Y, Robertson S et al (1997) Evaluation of radiation effect, tumor differentiation, and prostate specific antigen staining in sequential prostate biopsies after external beam radiotherapy for patients with prostate carcinoma. Cancer 27:81–89CrossRefGoogle Scholar
  19. Crook J, Malone S, Perry G et al (2000) Postradiotherapy prostate biopsies: what do they really mean? Results for 498 patients. Int J Radiat Oncol Biol Phys 48:355–367PubMedCrossRefGoogle Scholar
  20. Das P, Chen MH, Valentine K et al (2002) Using the magnitude of PSA bounce after MRI-guided prostate brachytherapy to distinguish recurrence, benign precipitating factors, and idiopathic bounce. Int J Radiat Oncol Biol Phys 54:698–702PubMedCrossRefGoogle Scholar
  21. Dattoli M, Cash J, Ross R et al (1997) Neoadjuvant hormone therapy and palladium-103 brachytherapy as salvage for locally recurrent prostate cancer. Proc Am Soc Clin Oncol 16:1118Google Scholar
  22. De la Taille A, Hayek O, Benson MC et al (2000) Salvage cryotherapy for recurrent prostate cancer after radiation therapy: the Columbia experience. Urology 55:79–84CrossRefGoogle Scholar
  23. Dutch cancer society (2010) SCK rapport kanker in Nederland, pp 141–145.
  24. Eggener SE, Scardino PT et al (2007) Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol 178:2260–2267PubMedCrossRefGoogle Scholar
  25. Eisenberg ML, Shinohara K (2008) Partial salvage cryoablation of the prostate for recurrent prostate cancer after radiotherapy failure. Urology 72:1315–1318PubMedCrossRefGoogle Scholar
  26. Freedland SJ, Humphreys EB, Mangold LA et al (2005) Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA 294:433–439PubMedCrossRefGoogle Scholar
  27. Gelet A, Chapelon JY, Poissonnier L et al (2004) Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. Urology 63:625–629PubMedCrossRefGoogle Scholar
  28. Grado GL, Collins JM, Kriegshauser JS et al (1999) Salvage brachytherapy for localized prostate cancer after radiotherapy failure. Urology 53:2–10PubMedCrossRefGoogle Scholar
  29. Grignon DJ, Hammond EH (1995) College of American Pathologists Conference XXVI on clinical relevance of prognostic markers in solid tumors. Report of the prostate cancer working group. Arch Pathol Lab Med 119:1122–1126PubMedGoogle Scholar
  30. Haider MA, Chung P, Sweet J et al (2008) Dynamic contrast-enhanced magnetic resonance imaging for localization of recurrent prostate cancer after external beam radiotherapy. Int J Radiat Oncol Biol Phys 70:425–430PubMedCrossRefGoogle Scholar
  31. Heesakkers RA, Hövels AM, Jager GJ, van den Bosch HC, Witjes JA, Raat HP, Severens JL, Adang EM, van der Kaa CH, Fütterer JJ, Barentsz J (2008) MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study. Lancet Oncol 9(9):850–856PubMedCrossRefGoogle Scholar
  32. Heidenreich A, Aus G, Bolla M et al (2008) EAU guidelines on prostate cancer. Eur Urol 53:68–80PubMedCrossRefGoogle Scholar
  33. Izawa JI, Madsen LT, Scott SM et al (2002) Salvage cryotherapy for recurrent prostate cancer after radiotherapy: variables affecting patient outcome. J Clin Oncol 20:2664–2671PubMedCrossRefGoogle Scholar
  34. Kalapurakal JA, Mittal BB, Sathiaseelan V (2001) Re-irradiation and external hyperthermia in locally advanced, radiation recurrent, hormone refractory prostate cancer: a preliminary report. Br J Radiol 74:745–751PubMedGoogle Scholar
  35. Kimura M, Mouraviev V, Tsivian M, Mayes JM, Satoh T, Polascik TJ (2010) Current salvage methods for recurrent prostate cancer after failure of primary radiotherapy. BJU Int 150:191–201CrossRefGoogle Scholar
  36. Koutrouvelis P, Hendricks F, Lailas N et al (2003) Salvage reimplantation in patient with local recurrent prostate carcinoma after brachytherapy with three dimensional computed tomography-guided permanent pararectal implant. Technol Cancer Res Treat 2:339–344PubMedGoogle Scholar
  37. Kovacs G, Potter R, Loch T et al (2005) GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer. Radiother Oncol 74:137–148PubMedCrossRefGoogle Scholar
  38. Lee B, Shinohara K, Weinberg V et al (2007) Feasibility of high-dose-rate brachytherapy salvage for local prostate cancer recurrence after radiotherapy: the University of California-San Francisco experience. Int J Radiat Oncol Biol Phys 67:1106–1112PubMedCrossRefGoogle Scholar
  39. Lee KL, Adams MT, Motta J (2008) Salvage prostate brachytherapy for localized prostate cancer failure after external beam radiation therapy. Brachytherapy 7:17–21PubMedCrossRefGoogle Scholar
  40. Lo K, Stock RG, Stone NN (2005) Salvage prostate brachytherapy following radiotherapy failure. Int J Radiat Oncol Biol Phys 63:S290–S291CrossRefGoogle Scholar
  41. Loening SA, Turner JW (1993) Use of percutaneous transperineal 198Au seeds to treat recurrent prostate adenocarcinoma after failure of definitive radiotherapy. Prostate 23:283–290PubMedCrossRefGoogle Scholar
  42. Master VA, Shinohara K, Carroll PR (2004) Ferromagnetic thermal ablation of locally recurrent prostate cancer: prostate specific antigen results and immediate/intermediate morbidities. J Urol 172:2197–2202PubMedCrossRefGoogle Scholar
  43. Moman MR, Van der Poel HG, Battermann JJ, Moerland MA, van Vulpen M (2009) Treatment outcome and toxicity after salvage 125-I implantation for prostate cancer recurrences after primary 125-I implantation and external beam radiotherapy. Brachytherapy 9:119–125PubMedCrossRefGoogle Scholar
  44. Moman MR, van den Berg CA et al (2010) Focal salvage guided by T2 weighted and dynamic contrast enhanced magnetic resonance imaging for prostate cancer recurrences. Int J Radiat Oncol Biol Phys 76(3):741–746PubMedCrossRefGoogle Scholar
  45. Mostofi F, Davis C, Sesterhenn I (1992) Pathology of carcinoma of the prostate. Cancer 70:235–253PubMedCrossRefGoogle Scholar
  46. Murat FJ, Poissonnier L, Rabilloud M et al (2009) Mid-term results demonstrate salvage high-intensity focused ultrasound (HIFU) as an effective and acceptably morbid salvage treatment option for locally radiorecurrent prostate cancer. Eur Urol 55(3):640–647PubMedCrossRefGoogle Scholar
  47. Nguyen PL, Chen MH, D’Amico AV et al (2007a) Magnetic resonance image-guided salvage brachytherapy after radiation in select men who initially presented with favorable-risk prostate cancer: a prospective phase 2 study. Cancer 110:4185–4192Google Scholar
  48. Nguyen PL, D′Amico AV, Lee AK, Suh WW (2007b) Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure, a systematic review of the literature. Cancer 110:1417–1428PubMedCrossRefGoogle Scholar
  49. Nguyen PL, Chen MH, Clark JA, Cormack RA, Loffredo M, McMahon E, Nguyen AU, Suh W, Tempany CM, D’Amico AV (2009) Patient-reported quality of life after salvage brachytherapy for radio-recurrent prostate cancer: a prospective phase II study. Brachytherapy 8:345–352PubMedCrossRefGoogle Scholar
  50. Pisters LL, English SF, Scott SM et al (2000) Salvage prostatectomy with continent catheterizable urinary reconstruction: a novel approach to recurrent prostate cancer after radiation therapy. J Urol 163:1771–1774PubMedCrossRefGoogle Scholar
  51. Pound CR, Brawer MK, Partin AW (2001) Evaluation and treatment of men with biochemical prostate-specific antigen recurrence following definitive therapy for clinically localized prostate cancer. Rev Urol 3(2):72–84PubMedGoogle Scholar
  52. Prestigiacomo AF, Stamey TA (1996) Physiological variation of serum prostate specific antigen in the 4.0 to 10.0 Ng/ml range in male volunteers. J Urol 155:1977–1980PubMedCrossRefGoogle Scholar
  53. Pucar D, Sella T, Schoder H (2008) The role of imaging in the detection of prostate cancer local recurrence after radiation therapy and surgery. Curr Opin Urol 18:87–97PubMedCrossRefGoogle Scholar
  54. Roach M III, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix consensus conference. Int J Radiat Oncol Biol Phys 65:965–974PubMedCrossRefGoogle Scholar
  55. Rouviere O, Valette O, Grivolat S et al (2004) Recurrent prostate cancer after external beam radiotherapy: value of contrast-enhanced dynamic MRI in localizing intraprostatic tumor–correlation with biopsy findings. Urology 63:922–927PubMedCrossRefGoogle Scholar
  56. Sanderson KM, Penson DF, Cai J et al (2006) Salvage radical prostatectomy: quality of life outcomes and long-term oncological control of radiorecurrent prostate cancer. J Urol 176:2025–2031PubMedCrossRefGoogle Scholar
  57. Scardino PT (1983) The prognostic significance of biopsies after radiotherapy for prostatic cancer. Semin Urols 1:243–252Google Scholar
  58. Stephenson AJ, Scardino PT, Bianco FJ et al (2004) Morbidity and functional outcomes of salvage radical prostatectomy for locally recurrent prostate cancer after radiation therapy. J Urol 172:2239–2243PubMedCrossRefGoogle Scholar
  59. Trotti A, Colevas AD, Setser A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13(3):176–181PubMedCrossRefGoogle Scholar
  60. Vaidya A, Soloway MS (2000) Salvage radical prostatectomy for radiorecurrent prostate cancer: morbidity revisited. J Urol 164:1998–2001PubMedCrossRefGoogle Scholar
  61. Van der Heide UA, Dehnad H, Hofman P, Kotte ANTJ, Lagendijk JJW, Van Vulpen M (2007) Analysis of fiducial marker based position verification in the intensity-modulated radiotherapy of patients with prostate cancer. Radiother Oncol 82:38–45PubMedCrossRefGoogle Scholar
  62. Van der Poel HG, Beetsma DB, van Boven H et al (2007) Perineal salvage prostatectomy for radiation resistant prostate cancer. Eur Urol 51:1565–1571PubMedCrossRefGoogle Scholar
  63. Wallner KE, Nori D, Morse MJ et al (1990) 125iodine reimplantation for locally progressive prostatic carcinoma. J Urol 144:704–706PubMedGoogle Scholar
  64. Wang H, Vees H, Miralbell R, Wissmeyer M, Steiner C, Ratib O, Senthamizhchelvan S, Zaidi H (2009) 18F-fluorocholine PET-guided target volume delineation techniques for partial prostate re-irradiation in local recurrent prostate cancer. Radiother Oncol 93(2):220–225PubMedCrossRefGoogle Scholar
  65. Ward JF, Sebo TJ, Blute ML et al (2005) Salvage surgery for radiorecurrent prostate cancer: contemporary outcomes. J Urol 173:1156–1160PubMedCrossRefGoogle Scholar
  66. Ward JF, Pagliaro LC, Pisters LL et al (2008) Salvage therapy for radiorecurrent prostate cancer. Curr Probl Cancer 32(6):242–271PubMedCrossRefGoogle Scholar
  67. Wong WW, Buskirk SJ, Schild SE et al (2006) Combined prostate brachytherapy and short-term androgen deprivation therapy as salvage therapy for locally recurrent prostate cancer after external beam irradiation. J Urol 176:2020–2024PubMedCrossRefGoogle Scholar
  68. Zagars GK, Pollack A (1997) Kinetics of serum prostate-specific antigen after external beam radiation for clinically localized prostate cancer. Radiother Oncol 44:213–221PubMedCrossRefGoogle Scholar
  69. Zelefsky MJ, Ben-Porat L, Scher HI et al (2005) Outcome predictors for the increasing PSA state after definitive external-beam radiotherapy for prostate cancer. J Clin Oncol 23:826–831PubMedCrossRefGoogle Scholar
  70. Zelefsky MJ, Kuban DA, Levy LB, Potters L, Beyer DC, Blasko JC et al (2007) Multi-institutional analysis of long-term outcome for stages T1–T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys 67:327–333PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of RadiotherapyUniversity Medical Center UtrechtUtrecht,The Netherlands

Personalised recommendations