Stone Nelson N, Unger Pamela, Crawford E David, Stock Richard G
Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY; Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Pathology, North Shore Health System at Lenox Hill Hospital, New York, NY.
Brachytherapy. 2015 Mar-Apr;14(2):124-30. doi: 10.1016/j.brachy.2014.08.046. Epub 2014 Sep 16.
To describe the diagnosis of local failure after prostate brachytherapy (BT) and treatment options when recurrence is present.
Review of literature for local recurrence after prostate BT and salvage therapy was performed. A total of 6 patients with prostate-specific antigen increase were identified as local failures by transperineal mapping biopsy (TPMB) and treated with targeted focused therapy using cryoablation.
Local recurrence after prostate BT occurs in 2-20% and is dose dependent. The biologic effective dose greater than 200 Gy(2) is associated with a less than 2% recurrence rate. Confirmatory biopsy should include both the prostate and seminal vesicles, as prostate cancer can be found in 20% of the latter. The pathologist should be experienced in evaluating post-irradiation tissue because of the difficulty in distinguishing benign irradiated prostate from residual or recurrent tumor. Whole gland salvage, whether by prostatectomy or cryoablation, is associated with high complication rates. Focal therapy has fewer complications but accurate targeting remains a concern. Newer diagnostic and targeting modalities such as multiparametric MRI and TPMB offer improved opportunity to increase lesion identification and ablation. A TPMB approach, which incorporates new biopsy needle design and interactive targeting software, may offer the best avenue to true focused therapy.
Local recurrences after prostate BT are uncommon because of high delivered radiation dose. When present, improved lesion identification and targeting may be associated with better cancer control and lower morbidity.
描述前列腺近距离放射治疗（BT）后局部失败的诊断以及复发时的治疗选择。
对前列腺BT后局部复发及挽救性治疗的文献进行综述。通过经会阴定位活检（TPMB）共确定6例前列腺特异性抗原升高的患者为局部失败，并采用冷冻消融靶向聚焦治疗。
前列腺BT后局部复发发生率为2%-20%，且与剂量相关。生物等效剂量大于200 Gy(2)时复发率低于2%。确诊活检应包括前列腺和精囊，因为20%的精囊中可发现前列腺癌。由于难以区分良性放疗后的前列腺与残留或复发肿瘤，病理学家应具备评估放疗后组织的经验。全腺挽救性治疗，无论是通过前列腺切除术还是冷冻消融，都与高并发症发生率相关。聚焦治疗并发症较少，但精确靶向仍是一个问题。多参数MRI和TPMB等更新的诊断和靶向方式为提高病变识别和消融提供了更好的机会。一种结合新活检针设计和交互式靶向软件的TPMB方法可能为真正的聚焦治疗提供最佳途径。
由于高放射剂量，前列腺BT后局部复发并不常见。出现复发时，改善病变识别和靶向可能与更好的癌症控制及更低的发病率相关。
