Local salvage treatment of post-brachytherapy recurrent prostate cancer via theranostic application of PSMA-labeled lutetium-177

Abstract

Both radical prostatectomy (RP) and radiotherapy (RT) are effective treatment alternatives of localized prostate cancer (PCa). However, 10% to 50% and 20% to 65% of the patients will experience biochemical recurrence within 15 years following RP and RT, respectively. According to the results of watchful waiting policy, the median time from biochemical recurrence to development of distant metastases is 3 years, more or less, which pushes clinicians to apply further curative local salvage therapy (LST). LST via various surgical (salvage RP) and non-surgical (high-intensity focused ultrasound, re-brachytherapy, cryotherapy, etc.) options can be offered in this setting. We present a case of locally recurrent PCa after brachytherapy. Considering our patients' body habitus, relatively young age, and marital status (just recently married), sexual side effects of androgen deprivation therapy, local adhesions induced by brachytherapy and prior abdominopelvic surgeries, the lack of institutional experience on cryotherapy/high-intensity focused ultrasound, and the risk of metastatic progression associated with watchful waiting, theranostic application of lutetium-177-labeled prostate-specific membrane antigen imaging and therapy was offered. To the best of our knowledge, this case represents the first example of the successful theranostic application of lutetium-177-labeled prostate-specific membrane antigen, as a LST option in the setting of locally recurrent PCa following curative intent brachytherapy for organ-confined PCa. (C) 2017 Elsevier Inc. All rights reserved.