Brachytherapy and early prostate cancer

Despite the absence of data from randomized clinical trials, brachytherapy — the implantation of radioactive seeds — has emerged as an alternative to current standard localized prostate cancer therapy. The paucity of evidence notwithstanding, both urologists and patients are attracted to brachytherapy because it is a minimally-invasive alternative to radical prostatectomy and external beam radiotherapy.

The Genitourinary Cancer Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative conducted a systematic overview of the literature to assess the role of brachytherapy in early prostate cancer. The authors found there is insufficient evidence to recommend unconditionally the use of brachytherapy over current standard therapy for localized prostate cancer. However, they do recommend that brachytherapy be considered for patients with favourable disease conditions (T1c or T2a tumours, a Gleason score of 6 or lower and serum PSA level of 10 µg/L or less).

In a related commentary, Dr. Curtis Nickel outlines the history of brachytherapy for prostate cancer and says Crook and associates have convinced him that, based on a “best-evidence-based” approach from the current literature, brachytherapy is feasible in selected patients with low-stage, low-volume and low-grade disease. However, he cautions that the report is sobering in that only a small minority of patients found to have prostate cancer meet the criteria for brachytherapy suggested by the authors.

Systematic overview of the evidence for brachytherapy in clinically localized prostate cancer — J. Crook et al

Brachytherapy for prostate cancer: Effective but…? — Dr. Curtis Nickel, Department of Urology, Kingston General Hospital; tel. 613 549-1436