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Salvage Treatment for Recurrent Prostate Cancer Following Brachytherapy: For Whom, When and Which?

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Interstitial Prostate Brachytherapy

Abstract

Brachytherapy to treat prostate carcinoma can be given either as permanent LDR seed implantation or as temporary HDR brachytherapy. Biochemical failure rate following brachytherapy is difficult to define. Multiple clinical characteristics have been described, and mostly the biochemical failure definition of a PSA rise by 2 ng/mL or more above the nadir is used. Local salvage curative therapy may be considered in a patient with a good performance status if a local recurrence is documented by prostate biopsy, with no evidence of disseminated disease and a life expectancy >10 years. The morbidity for the therapeutic salvage options can be significant. The different salvage treatments are surgery, radiotherapy or minimally invasive procedures, and also a conservative management with or without hormonal treatment can be considered. The salvage radical prostatectomy is the preferred treatment for motivated patients that accept the significant morbidity. Salvage brachytherapy seems to be a good alternative. The minimally invasive treatment modalities should be considered investigational in this setting. Optimal salvage hormonal timing still has to be defined but resulted in improved overall survival.

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Authors and Affiliations

  1. Department of Urology, Reinier de Graaf Gasthuis, 5011, Delft, GA 2600, The Netherlands

    Roos E. Stuurman-Wieringa MD

  2. Department of Urology, Academic Medical Center, 22660, 1100 DD, Amsterdam, The Netherlands

    Hiren S. Sodha MD, Jean J. M. H. C. de la Rosette MD, PhD & Theo M. de Reijke MD, PhD, FEBU

  3. Department of Urology, University of Thessaly, 6-8, Feidiou Street, 41221, Larissa, Greece

    Stavros Gravas MD, PhD

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  1. Roos E. Stuurman-Wieringa MD
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  2. Hiren S. Sodha MD
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  3. Stavros Gravas MD, PhD
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  4. Jean J. M. H. C. de la Rosette MD, PhD
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  5. Theo M. de Reijke MD, PhD, FEBU
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Correspondence to Theo M. de Reijke MD, PhD, FEBU .

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  1. Ratzeburger Allee 160, Lübeck, 23538, Germany

    György Kovács

  2. University College London, Mount Vernon Cancer Centre, Rickmansworth Road, London, HA62RN, United Kingdom

    Peter Hoskin

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Stuurman-Wieringa, R.E., Sodha, H.S., Gravas, S., de la Rosette, J.J.M.H.C., de Reijke, T.M. (2013). Salvage Treatment for Recurrent Prostate Cancer Following Brachytherapy: For Whom, When and Which?. In: Kovács, G., Hoskin, P. (eds) Interstitial Prostate Brachytherapy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36499-0_19

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