Definitive 125I prostate brachytherapy implant for low-risk prostate cancer in a patient with an ileal pouch-anal anastomosis: a case report.

PURPOSE

To report on the safe and effective use of a prostate brachytherapy implant for clinically low-risk prostate cancer in a patient with previous ileal pouch-anal anastomosis.

METHODS AND MATERIALS

A patient with a previous history of total proctocolectomy with ileal pouch-anal anastomosis was diagnosed with low-risk prostate cancer. He underwent prostate brachytherapy implant and his urinary, bowel, and sexual function were monitored preoperatively and regularly after his implant.

RESULTS

Approximately 1-year postimplant, the patient's serum prostate-specific antigen continued to decrease and urinary obstructive symptoms measured via a standardized patient-reported instrument increased transiently but returned to baseline. His sexual function remains slightly diminished. His self-reported bowel function has been essentially unchanged, and he specifically denies increased stool frequency, urgency, incontinence, tenesmus, or hematochezia.

CONCLUSIONS

Prostate brachytherapy appears to be both safe and effective for treating low-risk prostate cancer in patients with a pre-existing ileal pouch-anal anastomosis. Although there is a potential for significant late injury to the neorectum, a previous small series indicated that this had not been seen. Models currently used to predict normal tissue complication probabilities do not seem well applied to this case. The developments of algorithms that more correctly model this condition are encouraged.