Partial Prostate Salvage High Dose Rate Brachytherapy

Inclusion Criteria:

• Age >45 and Life expectancy >10 years

• Previous External Beam Radiotherapy (EBRT) dose up to 78Gray/39 fractions, 81Gray/45 fractions or 70 Gray/28 fractions or LDR brachytherapy with site ofrecurrence in an under-dosed or untreated site

• > 3 year interval since EBRT

• No late toxicity from prior EBRT > grade 2

• Rising PSA post EBRT > nadir + 2 ng/ml but < 10 ng/ml

• PSA Doubling time > 6 months

• Negative staging with CT scan of the abdomen/pelvis and bone scan

• Able to undergo multiparametric MRI with endorectal coil

• Radiographic evidence of dominant intraprostatic lesion (DIL) as only area ofrecurrence (i.e unifocal recurrence) and corresponding to site of original disease

• Biopsy confirmation of DIL with pathology review by British Columbia Cancer AgencyGenitoUrinary pathologist (TB)

• Willing to provide informed consent

• History and physical examination within 90 days of registration

• ECOG performance status 0-1 prior to registration

• IPSS < 16, or adequate voiding study (post void residual < 100cc and peak flow rate > 10 cc/second).

• No prior trans urethral prostatic resection

• Recurrence suitable for implant with HDR brachytherapy as assessed on ultrasoundsimulation (maximum PTV ideally < 65% of prostate volume)

• No history of inflammatory bowel disease or previous rectal surgery

• Suitable for procedure under anesthesia, spinal or general

• INR <2.5 and platelet count >75 x 109/L

• Androgen Deprivation Therapy may be initiated at the discretion of the treatingoncologist

Exclusion Criteria:

• Not compliant with criteria above

• Unable to give informed consent