Brachytherapy for prostate cancer: Present and future

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Brachytherapy is a key treatment modality for prostate cancer.
• Recent advancements necessitate an updated review of its applications.
• Evidence is evolving for various risk groups and treatment combinations.

Purpose of the Study:

• To analyze current validated and investigational uses of brachytherapy in prostate cancer management.
• To synthesize findings from recent high-impact publications and clinical trials.
• To provide evidence-based recommendations for different patient risk categories.

Main Methods:

• Systematic review of published studies (MEDLINE), randomized trials, and clinical recommendations.
• Inclusion of Delphi consensus findings where available.
• Analysis focused on brachytherapy's role in low-, intermediate-, and high-risk prostate cancer.

Main Results:

• Low-dose rate brachytherapy remains a standard for eligible low-risk patients.
• Three randomized trials support combining external beam radiation therapy with brachytherapy boost (LDR/HDR) for intermediate and high-risk patients.
• Monotherapy and salvage brachytherapy indications are still under investigation.

Conclusions:

• Low-dose rate brachytherapy alone is suitable for low-risk patients with good urinary status.
• Combination therapy (EBRT + brachytherapy boost) is recommended for intermediate- and high-risk prostate cancer.
• Further clinical investigation is warranted for high-dose rate brachytherapy monotherapy and salvage brachytherapy.