Outcomes and toxicities in patients with intermediate‐risk prostate cancer treated with brachytherapy alone or brachytherapy and supplemental external beam radiation therapy

Abstract

Brachytherapy monotherapy results in equal biochemical and distant control in both patients with one and more than one intermediate-risk features. While no significant benefit was shown, we believe that the addition of EBRT may prevent recurrence in patients with multiple intermediate-risk features and should be considered.

Brachytherapy: An overview for clinicians

“…Apart from cervical cancer, major indications for brachytherapy are endometrial, prostate, and breast cancer (Table ). For these tumor sites, the level of evidence for brachytherapy has come from randomized controlled studies focusing not only on local control but also including OS and QOL analysis (Table ) …”

“…In fact, there is a large amount of evidence that increasing the dose to the prostate is associated with an improvement in biochemical progression‐free survival in PCa . On the basis of accumulating evidence from nonrandomized studies and from one single randomized comparison that included a few patients, permanent seed brachytherapy as monotherapy is equivalent to radical prostatectomy in patients who have low‐risk PCa, with less urinary incontinence and/or erectile dysfunction in the short term . A feasibility study has shown that recruitment to surgery versus brachytherapy is not feasible using 2‐step randomization, illustrating the difficulty of comparing both strategies .…”

Brachytherapy for the urologist: A multidisciplinary team update for 2019

“…Whilst many men may notice a deterioration in urinary symptoms immediately following BT, the majority have returned to baseline within 12 months with a change in IPSS score of just 1–2 points. 9,28 Some evidence suggests that more modern techniques such as 4D BT may result in a more rapid and complete resolution of symptoms.…”

“…Urinary retention rates vary widely from 7–34% of cases. 28–30 As prostate size and initial symptom scores are predictors of retention, with appropriate patient selection, the risk of acute urinary retention can be reduced. 10 Whilst acute retention can be managed with urethral catheterisation, the duration should be minimised to reduce infection risk.…”

“…Patients can expect some deterioration from their baseline function initially, with reports of a least one point drop within the first 2 years in up to 39%. 28,35 The time taken to return to baseline function can vary between studies, with 65% achieving baseline function within 18 months in some and others reporting 70–80% preserved potency at 5 years. 9,36…”