Localized prostate cancer: brachytherapy

Brachytherapy is a treatment for localized prostate cancer that has become popular with physicians and patients. The use and convenience of transrectal ultrasound and transperineal placement of the sources make contemporary forms of this procedure more accurate and more patient-friendly than their predecessors. In addition, the early detection of cancer by the use of prostate-specific antigen (PSA) makes contemporary tumors more amenable to successful treatment by such a localized technique. Brachytherapy offers cancer control rates at 5 years, as measured by PSA, that seem to be as effective as surgery and external beam therapy. Less information is available for 10 years, and none afterward. The acute urinary morbidity rate of brachytherapy is higher than for external beam therapy, but the late urinary morbidity rate is probably equal. The rectal morbidity rate is less. The risk of erectile impotence is uncertain but not as low as originally hoped. The use of external radiation in combination with brachytherapy may increase 5-year tumor control rates but is substantially more expensive and likely carries an increased risk of morbidity. Newer forms of brachytherapy such as magnetic resonance-guided and high-dose-rate temporary implants have vocal advocates but a shorter track record and fewer published prospective studies. Their use remains investigational. Therefore, prostate brachytherapy remains a reasonable option for men with early stage disease, but there remain unanswered questions regarding long-term efficacy and morbidity.