Long‐term outcomes of partial prostate treatment with magnetic resonance imaging‐guided brachytherapy for patients with favorable‐risk prostate cancer

Abstract

Partial prostate treatment with brachytherapy may be associated with higher rates of distant metastasis and PCSM for patients with intermediate-risk disease after long-term follow-up. Treatment of less than the full gland may not be appropriate for this cohort.

Partial gland therapy for prostate cancer

“…We read with great interest the recently published article by King et al, 1 in which they report that partial gland ablation using brachytherapy may be associated with higher rates of distant metastasis and prostate cancerspecific mortality for patients with intermediate-risk disease. The authors concluded that a subtotal treatment template may not be appropriate for this subset of patients.…”

“…The nature of prostate biopsy is such that the transition zone is always at least partially sampled. Without sufficient knowledge to understand whether the cancer extended to or originated from the transition zone, it would be impossible to plan a successful treatment, thus contributing to inferior oncological outcomes in the study by King et al 1 Finally, the surveillance protocol was inadequate. Although to our knowledge the optimal postablation surveillance strategy is not well understood even today, there is a general consensus that prostate-specific antigen (PSA) alone is insufficient and should be combined with interval sampling and imaging.…”

“…We would like to thank Hoge et al for their insightful correspondence regarding our experience with partial prostate brachytherapy. 1 There have been rapid changes in focal therapy over the past decade, especially with regard to the incorporation of multiparametric magnetic resonance imaging (mpMRI) and biopsy-based surveillance regimens. However, our partial prostate brachytherapy experience remains clinically relevant in the current era.…”

Very low‐risk versus low‐risk prostate cancer: A distinction worth keeping

“…There are very limited data on the differences between VLR and LR disease for other treatment modalities because stratifying patients into VLR and LR groups will typically not impact treatments other than AS. King et al 9 using partial prostate treatment with MRI image‐guided brachytherapy reported that the 10‐year biochemical progression‐free survival rates for patients with VLR and LR disease were 77.2% and 51.3, respectively 9 . The 10‐year metastasis estimates for patients with VLR and LR disease were 0.8% and 3.5%, respectively.…”

Reply to Partial gland therapy for prostate cancer

“…We would like to thank Hoge et al for their insightful correspondence regarding our experience with partial prostate brachytherapy . There have been rapid changes in focal therapy over the past decade, especially with regard to the incorporation of multiparametric magnetic resonance imaging (mpMRI) and biopsy‐based surveillance regimens.…”