Urological oncology

Abstract

Prostate brachytherapy has become an accepted treatment modality for localized prostate cancer. Longterm biochemical and biopsy data confirm the early positive impressions that brachytherapy is as valid a treatment option as radical prostatectomy or EBRT. Quality-of-life data also look promising, but more follow-up data are needed. Is brachytherapy as good as or perhaps better than radical prostatectomy? This question cannot be answered yet. Well-controlled, randomized studies are needed. In the meantime, the clinician will have to rely on the available published data. Permanent interstitial brachytherapy for the management of carcinoma of the prostate glandMerrick GS, Wallner KE, Butler WM Schiffler Cancer Center, Wheeling Hospital, Wheeling, West Virginia, USA J Urol. 2003; 169: 1643-1652 Purpose: We summarize the permanent prostate brachytherapy literature, including biochemical outcomes, quality of life parameters and areas of controversy.Materials and Methods: The permanent prostate brachytherapy literature was reviewed using Medline searches to ensure completeness.Results: Using various planning and intraoperative techniques the majority of the brachytherapy literature demonstrates durable biochemical outcomes for patients with low, intermediate and high risk features. For low risk patients there is no advantage to combining supplemental external beam radiation therapy with brachytherapy. In addition, supplemental external beam radiation therapy may not improve biochemical outcomes for patients at intermediate and high risk if the target volume consists of the prostate with a generous periprostatic margin. There is no defined role for adjuvant hormonal manipulation. Although a reliable set of pretreatment criteria to predict implant related morbidity is not available, severe urinary and rectal morbidity is rare. The incidence of brachytherapy induced erectile dysfunction is significantly greater than initially reported but the majority of patients respond favorably to sildenafil.Conclusions: Continued refinements in brachytherapy planning and implementation techniques, postimplantation evaluation and continued elucidation of the etiology of urinary, bowel and sexual dysfunction should result in further improvements in biochemical and quality of life outcomes.