Department of radiation oncology, institut de cancérologie de l'ouest site Saint-Herblain, boulevard du Professeur-Jacques-Monod, 44800 Nantes Saint-Herblain, France.
Department of radiation oncology, institut de cancérologie de l'ouest site Saint-Herblain, boulevard du Professeur-Jacques-Monod, 44800 Nantes Saint-Herblain, France.
Cancer Radiother. 2021 Jul;25(5):476-479. doi: 10.1016/j.canrad.2020.06.027. Epub 2021 Mar 21.
Metastatic recurrence in an atypical site, such as the perineum, can occur after prostatectomy, cryotherapy, or brachytherapy, but is uncommon. To our knowledge, this is only the third case of perineal recurrence of prostatic cancer along a low dose rate brachytherapy needle track. A 64-year-old man was referred to an urologist with an increased PSA of 6.9ng/mL in December 2008. There were no urinary symptoms. Prostatic biopsies revealed a Gleason 6 adenocarcinoma (3+3), and he was treated with low dose rate brachytherapy in May 2009. Sixty-seven seeds of iodine 125 were loaded under ultrasound control, and the PSA subsequently fell to a nadir of 1.19ng/mL in November 2015. Eight years (May 2017) after the initial treatment, the PSA rose to 5.2ng/mL. Pelvic MRI and choline PET revealed a nodule in the region of the left internal obturator muscle. Nodule biopsies confirmed prostatic origin. This perineal recurrence is thus most likely related to seeding of tumour cells along the track of a brachytherapy needle. To our knowledge, this is only the fourth case of perineal recurrence of prostatic cancer along a low-dose rate brachytherapy needle track. Perineal recurrence of prostatic cancer along a LDR brachytherapy needle track can occur. Improved imaging techniques may help to identify this type of recurrence earlier and optimise treatment.
前列腺癌的转移复发，即使在前列腺切除术、冷冻疗法或近距离放射疗法后，也通常发生在不典型部位，如会阴部，但并不常见。据我们所知，这仅是第三次报道的前列腺癌会阴部沿低剂量率近距离放射疗法针道复发的病例。一位 64 岁的男性因 PSA 升高至 6.9ng/mL 于 2008 年 12 月就诊于泌尿科医生。他没有出现泌尿系统症状。前列腺活检显示为 Gleason 6 腺癌（3+3），并于 2009 年 5 月接受了低剂量率近距离放射疗法治疗。在超声引导下植入了 67 颗碘 125 种子，PSA 随后于 2015 年 11 月降至最低点 1.19ng/mL。在初始治疗 8 年后（2017 年 5 月），PSA 上升至 5.2ng/mL。盆腔 MRI 和胆碱 PET 显示左侧内收肌区域有一个结节。结节活检证实为前列腺起源。因此，此次会阴部复发很可能与肿瘤细胞沿近距离放射疗法针道播种有关。据我们所知，这仅是第四次报道的前列腺癌会阴部沿低剂量率近距离放射疗法针道复发的病例。前列腺癌会阴部沿 LDR 近距离放射疗法针道的复发是可能的。改进的成像技术可能有助于更早地发现这种类型的复发，并优化治疗。
