A critical analysis of the long-term impact of brachytherapy for prostate cancer: a review of the recent literature

Abstract

Purpose of review: A number of articles have been published in the past several months providing long-term follow-up data on large brachytherapy series from centers of excellence or highly experienced individual practitioners. Our purpose is to review this recent literature and place it in context, especially as compared with notable articles in the recent past that have described less favorable outcomes.

Recent findings: A total of 3773 patients were included in three large permanent seed implant studies, the first with almost exclusively low-dose rate permanent seed brachytherapy monotherapy, the second including a large proportion of patients receiving 6 months of androgen suppression, and the third including both supplemental external beam radiotherapy (EBRT) and hormonal therapy. The 7-10 year biochemical no evidence of disease rates ranged from 94 to 95.6%, with the vast majority of patients achieving prostate specific antigen nadirs less than 0.4 ng/ml. Eight to 10 year follow-up on high-dose rate brachytherapy patients treated with combined EBRT and an high-dose rate boost are equally impressive, especially considering that these series contain a large proportion of men with unfavorable disease.

Summary: Both low-dose rate and high-dose rate prostate brachytherapy, either alone or given as a boost combined with moderate-dose EBRT, provide impressive long-term disease control and may be the optimal form of intraprostatic dose escalation.