The evolution of brachytherapy for prostate cancer

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Brachytherapy (BT) is a radiotherapy technique for prostate cancer using either low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation.
• Both LDR-BT and HDR-BT are acceptable treatment options for select patients with prostate cancer, regardless of risk group.

Observation:

• HDR-BT offers advantages such as versatile source use, reduced operator dependence, and fewer acute irritative symptoms compared to LDR-BT.
• LDR-BT provides benefits including simpler logistics, lower initial costs, no need for a shielded room, single-session treatment, and extensive clinical trial data.
• Comparative studies indicate similar oncological outcomes between HDR-BT and LDR-BT, as well as when compared to external beam radiotherapy (EBRT) or surgery.

Findings:

• Five-year freedom from biochemical failure rates for low-risk, intermediate-risk, and high-risk prostate cancer patients treated with brachytherapy are consistently high (>85%, 69-97%, and 63-80%, respectively).
• Ten-year survival rates demonstrate excellent long-term control: overall survival (>85%), distant metastasis (<10%), and cancer-specific mortality (<5%).
• The combination of brachytherapy with EBRT is a suitable approach for select intermediate-risk and high-risk prostate cancer patients.

Implications:

• Brachytherapy, both LDR and HDR, demonstrates favorable long-term oncological outcomes and low rates of severe toxicity (<4%).
• Patients undergoing brachytherapy report improved quality of life compared to those treated with surgery.
• Brachytherapy represents a valuable and effective treatment modality for prostate cancer management across various risk stratifications.