The evolution of brachytherapy for prostate cancer

Nicholas G. Zaorsky, Brian J. Davis, Paul L. Nguyen, Timothy N. Showalter, Peter J. Hoskin, Yasuo Yoshioka, Gerard C. Morton, Eric M. Horwitz

Research output: Contribution to journalReview article

36 Scopus citations

Abstract

Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and-typically-fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69-97%, and 63-80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3-4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.

Original languageEnglish (US)
Pages (from-to)415-439
Number of pages25
JournalNature Reviews Urology
Volume14
Issue number7
DOIs
StatePublished - Jul 1 2017

All Science Journal Classification (ASJC) codes

  • Urology

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    Zaorsky, N. G., Davis, B. J., Nguyen, P. L., Showalter, T. N., Hoskin, P. J., Yoshioka, Y., Morton, G. C., & Horwitz, E. M. (2017). The evolution of brachytherapy for prostate cancer. Nature Reviews Urology, 14(7), 415-439. https://doi.org/10.1038/nrurol.2017.76