Re-implantation after insufficient primary 125-i permanent prostate brachytherapy

INTRODUCTION: We describe five patients receiving a re-implantation (RI) after post-operative dosimetry of the primary 125-I permanent prostate brachytherapy (BT) for prostate cancer revealed an insufficient dose coverage. MATERIALS AND METHODS: Five out of 222 consecutive patients treated (from March, 2001 to August, 2012) with 125-I BT, received a RI after dosimetric verification by CT and MRI fusion four to eight weeks after implantation displayed an insufficient dose coverage. RIs were performed with 10 to 19 seeds, three to four months after primary intervention. Dosimetry after RI showed an improved and sufficient total dose coverage in all patients. RESULTS: At last follow-up (18 to 99 months, median 57 months), none of the patients had relevant implant associated side-effects. Functional outcome was comparable to patients after one-time implantation. PSA levels post intervention showed a decreasing tendency in 4 patients. One patient had a local recurrence after 12 months. CONCLUSION: In our series, approximately 2% of the patients treated with permanent prostate BT required a RI due to insufficient dose coverage. None of the patients who underwent RI experienced complications. Our series, although only with 5 cases and limited follow-up, along with other published reports, demonstrates good tolerability.