Raleigh David R, Hsu I-Chow, Braunstein Steve, Chang Albert J, Simko Jeffry P, Roach Mack
Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; Department of Anatomic Pathology, University of California San Francisco, San Francisco, CA; Department of Urology, University of California San Francisco, San Francisco, CA.
Brachytherapy. 2015 Mar-Apr;14(2):185-8. doi: 10.1016/j.brachy.2014.11.008. Epub 2014 Dec 19.
Prostate cancer seeding after needle biopsy has been reported in the perineum, rectal wall, and periprostatic soft tissue. In this article, we report the results of a localized prostate cancer recurrence in the bladder following protrusion of a single high-dose-rate brachytherapy catheter through the bladder wall at the ultimate site of failure.
A 62-year-old man with high-risk prostate adenocarcinoma was treated with long-term androgen deprivation therapy, intensity-modulated radiation, and high-dose-rate brachytherapy boost. He developed biochemical recurrence 4 years after treatment, and a CT scan of the pelvis revealed a nodule in the posterior, inferior bladder wall.
Surgical pathology following transurethral resection of tumor within the bladder was consistent with high-grade prostate adenocarcinoma. The patient's prostate-specific antigen level fell to the range of normal postoperatively, and whole body imaging, including a multi-parametric MRI of the prostate with diffusion and spectroscopy, failed to reveal any other sites of disease. Review of the CT scan obtained for dosimetry at the time of brachytherapy demonstrated a lone catheter protruding through the bladder wall at the site of eventual recurrence. The tumor recurred in the bladder 12 months later, once more without evidence of disease within the prostate itself or distantly, and the patient was started on salvage androgen deprivation therapy.
This case is the first report of prostate cancer recurrence in the bladder wall after brachytherapy and raises questions about prostate cancer biology, brachytherapy technique, and the timing of brachytherapy boost relative to whole pelvic radiotherapy for prostate cancer.
针吸活检后前列腺癌种植已在会阴、直肠壁和前列腺周围软组织中被报道。在本文中，我们报告了一例在高剂量率近距离放射治疗单根导管从膀胱壁穿出至最终失败部位后膀胱内出现局限性前列腺癌复发的病例。
一名62岁高危前列腺腺癌男性患者接受了长期雄激素剥夺治疗、调强放疗和高剂量率近距离放疗增敏。治疗4年后出现生化复发，盆腔CT扫描显示膀胱后壁有一个结节。
经尿道切除膀胱内肿瘤后的手术病理结果与高级别前列腺腺癌一致。患者术后前列腺特异性抗原水平降至正常范围，包括前列腺多参数MRI弥散加权成像和波谱分析在内的全身影像学检查未发现其他疾病部位。回顾近距离放疗时用于剂量测定的CT扫描发现，在最终复发部位有一根导管穿出膀胱壁。12个月后肿瘤在膀胱内复发，同样在前列腺本身或远处未发现疾病证据，患者开始接受挽救性雄激素剥夺治疗。
该病例是近距离放疗后膀胱壁前列腺癌复发的首例报道，并引发了关于前列腺癌生物学、近距离放疗技术以及前列腺癌近距离放疗增敏相对于全盆腔放疗时机的问题。
