Low-dose-rate brachytherapy for low-grade prostate cancer

Area of Science:

• Oncology
• Radiotherapy
• Urology

Background:

• Prostate cancer is a radiosensitive malignancy.
• Radiotherapy, including low-dose-rate brachytherapy, is utilized for curative and palliative care.
• Low-dose-rate brachytherapy delivers precise, high radiation doses internally.

Purpose of the Study:

• To systematically review the evidence for low-dose-rate brachytherapy in prostate cancer treatment.
• To compare its efficacy, adverse effects, and cost-effectiveness against other treatment modalities.
• To assess the current evidence base, particularly in the context of its establishment in Norway.

Main Methods:

• Systematic review of existing literature.
• Searched databases: Cochrane Library, Current Controlled Trials, Medline, Embase, NICE.
• Included 43 studies, encompassing treatment, outcomes, adverse effects, and health economics.

Main Results:

• Uncertainty remains regarding the optimal treatment (brachytherapy, external radiotherapy, prostatectomy) due to methodological variations.
• Low-dose-rate brachytherapy shows more grade 2-3 urogenital adverse effects than prostatectomy but better sexual function and less incontinence.
• The treatment appears socioeconomically cost-effective.

Conclusions:

• Evidence for therapeutic effect and toxicity of low-dose-rate brachytherapy in low-risk prostate cancer is well-documented.
• High-quality prospective randomized multi-center trials with overall survival as an endpoint are lacking.
• Further research is needed to establish optimal treatment selection criteria.