Perineal recurrence of prostate ductal adenocarcinoma after transperineal brachytherapy: a case report and literature review.

Perineal recurrence after brachytherapy is an exceedingly rare complication. Moreover, ductal adenocarcinoma is a rare histological variant of prostate cancer. Herein, we describe a case of perineal recurrence from ductal adenocarcinoma of prostate after low-dose-rate brachytherapy (LDR-BT) in a 65-year-old male patient. The patient had localized prostate cancer, for which he received LDR-BT; however, he experienced perineal recurrence 2 years after receiving LDR-BT. Surgical excision was attempted, but we were unable to remove the whole tumor, owing to invasion to surrounding tissue. Pathological examination of resected tumor showed ductal adenocarcinoma of the prostate. External beam radiation therapy and high-dose-rate brachytherapy (HDR-BT) were performed for residual tumor. Mild mediastinal lymph node swelling was observed during clinical course of the disease. Hence, androgen deprivation therapy was administered with abiraterone after radiation therapy, and prostate-specific antigen level decreased to undetectable level. Biochemical failure after transperineal brachytherapy for prostate cancer should be considered as a perineal recurrence.

Placement of SpaceOAR hydrogel spacer for prostate cancer patients treated with iodine-125 low-dose-rate brachytherapy.

OBJECTIVES: The aim of the present study was to report on our early experience with hydrogel spacer (SpaceOAR) placement in combination with iodine-125 low-dose-rate brachytherapy for prostate cancer. METHODS: From April 2018, SpaceOAR hydrogel spacer was placed in 100 consecutive patients undergoing iodine-125 low-dose-rate brachytherapy. Complications and the status of the placement were evaluated. Deformation of the prostate by the spacer was examined measuring prostate diameters and evaluating the change from preoperative status. The position of the prostate was similarly examined by evaluating the change in distance between the pubic symphysis and the prostate. Post-plan dosimetric data were compared with 200 patients treated without a spacer. RESULTS: No complications were found during either the intraoperative or perioperative periods. The mean displacement distance of 11.64 mm was created, the mean value before spacer placement was 0.28 mm (P < 0.0001). The change of the prostate diameters showed a positive increase in all directions, with no significant negative change in any one direction. Regarding the change in distance between pubic symphysis and the prostate, no significant shortening trend was observed between the two groups (P = 0.14). Whereas the dosimetric parameters showed means of 0.001 and 0.026 cc for RV150 and RV100 in the spacer group, they were 0.025 and 0.318 cc, respectively, in the non-spacer group, showing a significant decrease in both parameters (P < 0.001). CONCLUSIONS: Prostate deformation secondary to hydrogel placement might adversely affect dosimetric parameters in patients undergoing low-dose-rate brachytherapy. However, a significant reduction in the rectal dose can be adopted without adversely affecting the other parameters related to treatment outcome.

[EFFECTIVENESS AND SAFETY OF TADALAFIL IN VERY ELDERLY PATIENTS WITH LOWER URINARY TRACT SYMPTOMS].

(Aim) The α-1 blockers have been used as first-line therapy for benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS). A new phosphodiesterase type 5 inhibitor, tadalafil, was approved in 2014 and received a Grade A recommendation in the 2017 clinical practice guidelines for LUTS. In this study, we examined the effectiveness and safety of tadalafil in very elderly patients with LUTS. (Subjects and methods) The subjects were 84 very elderly patients, at least 75 years of age, with BPH/LUTS for which they had been administered tadalafil.Data of the 71 patients were retrospectively reviewed in terms of the International Prostate Symptom Score (IPSS), quality of life (QOL) index, overactive bladder symptom score (OABSS), maximum flow rate and postvoid residual urine volume at baseline and at weeks 4, 8, 12, and 24. We also examined the safety of tadalafil therapy. (Results) Patient characteristics were: median age 80.1±4.38 years, prostate volume 41.2±24.3 cc and IPSS 15.7±5.68. Patients who had undergone treatment for BPH/LUTS prior to tadalafil therapy accounted for 67.9% of the study population.Significant improvements occurred in IPSS, QOL and OABSS at week 4, and the improvements were maintained until week 24. As for postvoid residual urine test results, a significant improvement was seen at week 8 only.Adverse events were noted in 9 patients (10.7%), but only 5 (6.0%) needed to discontinue tadalafil therapy. (Conclusion) Tadalafil is considered to be a highly effective and safe drug in very elderly patients with LUTS.