Role of Brachytherapy in Management of Localized Prostate Cancer

Abstract

In the absence of an optimal modality for the treatment of localized prostate carcinoma, and since not all approaches are suitable for all patients, brachytherapy seems as an attractive option. Brachytherapy is appealing to older men that are not physically able to withstand a complicated surgical prostatectomy, as well as for younger men that wish to maintain a normallife-style. With the development of computer-based planning and improvement of the implantation procedure, brachytherapy has shown to produce comparable outcomes to the other modalities, with a decrease in gastrointestinal and variable genitourinary complication compared to external beam radiation. Recent technological advances in HDR brachytherapy have increased the appeal and application of this approach for patients with localized prostate cancer. Current treatment methods allow optimization of dose distribution thus administering a high dose of radiation that tightly conforms to the targeted volume, which may open the door for dose escalation studies and allow better coverage of extraprostatic disease in higher risk disease that was not previously feasible, therefore, improving therapeutic outcome while minimizing radiationexposure to adjacent healthy organs further minimizing the adverse events. Also, it shows favorable toxicity profiles and potency preservation compared to LDR. Ongoing clinical studies are investigating the feasibility of performing a single implantation, during which only one treatment is administered. This approach would reduce health care costs and medical personnel workload, and it would likely improve patient comfort and convenience. However, several issues regarding HDR brachytherapy remain to be adequately addressed. The ideal radiation dose and number of fractions are not yet known because direct comparisons between various treatment regimens are lacking. Randomized clinical trials are needed to directly compare HDR brachytherapy with other forms of treatment for prostate cancer particularly LDR brachytherapy and external-beam RT. Randomized clinical trials are also needed to determine whether androgen suppression should be integrated into the overall treatment strategy for some patients.