Open Access

RESIDENT’S CORNER

HDR monotherapy for man with radiotherapy contraindications and prostate cancer

Andrea Lo¹, Robert K. Nam², D. Andrew Loblaw^3,4

1 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
2 Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
3 Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
4 Department of Health, Policy, Measurement and Evaluation, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
Address correspondence to Dr. Andrew Loblaw, Sunnybrook Health Sciences Centre, T2-142, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada

Canadian Journal of Urology 2011, 18(4), 5839-5843.

Abstract

There is debate about the optimal management of high risk localized prostate cancer. Initial options include surgery or radiation combined with androgen deprivation therapy. We describe a case of a patient with contraindications to radiotherapywhowasmanagedwithhighdoserate(HDR) brachytherapy as his sole treatment.
A medically operable patient presented with a T2c N0 M0 Gleason9adenocarcinomawithaninitialPSAof19.9ng/mL. Previously, he had severe ulcerative colitis managed with pancolectomy and a neorectum fashioned from ileum anastomosedbehindhisprostate.Afteranegativeextended lymph node dissection, a HDR brachytherapy implant of 35Gyin5fractionsover3dayswasdelivered.Noandrogen deprivationtherapywasused.Thetreatmentwasextremely welltoleratedintheshortandlongtermwithnosignificant bowel or bladder side effects observed in follow up. After 7 years, his PSA was 0.04 ng/mL.
The excellent long-term biochemical control and minimal radiation toxicity observed in this patient suggests that HDR monotherapy may be a safe and effective alternative for high risk prostate cancer patients in whom EBRT is contraindicated.

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