What is appropriate local salvage therapy after prostate brachytherapy failure?

I would not re-irradiate the prostate using EBRT. I would only use HDR brachytherapy. I would give 6Gy x 6 /2 implants based on our published experience. Alternative fractionation is 8Gy x 4 based MSKCC study. There is also data on permanent seed salvage. That is mostly for post EBRT failure. Howeve...

I agree with @Dr. First Last's excellent comments. I add the following

1. reference to a recently published paper from our institution exploring the subject: https://www.ncbi.nlm.nih.gov/pubmed/27693225

Dr. Kwok reports 3yr BFFS 69% with 2/11 pts with grade 3 toxicity

2. mpMRI may be obscured by seed c...

The nice people who use this website sure do keep coming up with some challenging questions. As such, we once again consider a dilemma without much evidence to guide us - similar to cases reviewed in the Red Journal Gray Zone. Of course, start with an H&P and follow basic oncologic principles. The g...

To my knowledge the largest series is from Dr Hsu. He already answered here. Fifty two patients with only a single case of Grade 3 toxicity with a 6 fraction x 6 Gy over 2 implants (https://www.ncbi.nlm.nih.gov/pubmed/23474112)

The other relevant publication is the prospective trial from Dr Yamada wi...