Female urology

Abstract

Editorial CommentThese two papers essentially cover all available knowledge on the clinical application on permanent interstitial seed brachytherapy for prostate cancer.Next to radical prostatectomy, permanent interstitial prostate (low-dose-rate, LDR) brachytherapy has become an accepted modality for treating localized prostate cancer. These papers are very thorough and up-todate overviews on the history, the technical aspects, the treatment results and side effects of this new therapeutic option. Based on previous ultrasound inventions in Europe, the technique was refined basically in the US and realized on biplanar linear array ultrasound probes. This tool, together with an expert technique, forms the basis of a successful brachytherapy. Furthermore, software advances for the preplanning and the procedure resulted in new programs that now can accurately monitor each seeds position and radiation contribution.Patient selection is crucial for successful therapy and the ideal candidate has low risk prostate cancer, defined as PSA of 10 or less, Gleason score of 6 or less and clinical stage T2a or less. Patients who present with more advanced features will require additional therapy, which is also addressed in depth in the articles.The important aspect of doses is also focussed in detail. Generally, a dose of 140 Gy can be considered as threshold, as doses of less than 140 Gy had inferior results. Doses of 140 Gy and higher had outcomes comparable to radical prostatectomies.The treatment results of studies all over the world are given for low risk patients, and also for patients with high-risk cancer. Low risk patients treated with brachytherapy have treatment results comparable to radical prostatectomy results. High-risk patients if treated in combination with hormones and/or external radiation therapy do fairly well with still room for improvement.Treatment morbidity and side effects are also given in detail and are clearly inferior to radical prostatectomy results. Urinary retention rates vary between 1.5 to 34%, whereas late urinary complications including stricture, incontinence, and proctitis are very rare, given the right dose and technique.An important aspect is the results on erectile dysfunction. Here, brachytherapy clearly has an advantage over radical prostatectomy, with potency preservation rates in the seventies to nineties, if brachytherapy is given alone. These data still can be improved by edition of files.In summary, permanent interstitial prostate cancer brachytherapy has become an accepted treatment modality for localized prostate cancer. Therapeutic validity is high and side effects are very low as compared to other curative alternatives. Therefore this technique will represent a clear option in the armamentarium of the urologic surgeon.