Brachytherapy: state‐of‐the‐art radiotherapy in prostate cancer

Chao, Michael; Grimm, Peter; Yaxley, John; Jagavkar, Raj; Ng, Michael; Lawrentschuk, Nathan

doi:10.1111/bju.13252

Cited by 25 publications

(17 citation statements)

References 70 publications

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“…An alternative is radiotherapy, with the options of external beam radiotherapy (EBRT) or brachytherapy [12]. Low dose rate brachytherapy can be used as monotherapy with 3 + 4 disease, particularly if only low-volume disease (percent cores involved <33%) is present.…”

Section: Discussionmentioning

confidence: 99%

Feasibility for active surveillance in biopsy Gleason 3 + 4 prostate cancer: an Australian radical prostatectomy cohort

et al. 2016

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Retrospective review of 929 patients, with biopsy proven GS 3 + 3 and 3 + 4 PCa, undergoing upfront radical prostatectomy (RP) was performed. Suitability for AS was adapted from protocols by Royal Marsden Hospital, University of Toronto, and PRIAS by allowing Gleason 3 + 4 disease.The outcomes assessed were adverse pathology at RP (upgrading ≥GS 4 + 3 and/or upstaging ≥pT3) and biochemical recurrence (BCR) after RP. ResultsAdverse pathology at RP was compared between GS 3 + 3 vs 3 + 4 groups. When selecting patients using Royal Marsden (n = 714) or University of Toronto (n = 699) protocols, there was statistically significantly more adverse pathology at RP in GS 3 + 4 group (21% vs 31%, P = 0.0028 and 19% vs 33%, P=<0.001 respectively). Using the more stringent PRIAS protocol (n = 198), there was no statistical significant difference in groups.There was no difference in BCR survival between biopsy GS 3 + 3 and 3 + 4 groups, regardless of which AS protocol assessed. Pre-operative PSA and clinical staging were the predictors for BCR. ConclusionPresence of Gleason 3 + 4 at biopsy, when compared to 3 + 3, increases the risk of adverse pathology being present at radical prostatectomy for less stringent selection criteria. When considering AS, a stricter protocol such as PRIAS, limiting PSA density and number of positive cores to ≤2, appears to decrease the risk of adverse pathology. No differences in BCR were seen between biopsy 3 + 3 and 3 + 4 disease, regardless of AS selection criteria.

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Section: Discussionmentioning

confidence: 99%

Feasibility for active surveillance in biopsy Gleason 3 + 4 prostate cancer: an Australian radical prostatectomy cohort

et al. 2016

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“…An enlarged prostate may also lead to pubic arch interference and difficulties in needle placement within the prostate gland. 8 Brachytherapy insertions are not recommended following a transurethral resection of the prostate within the previous three to six months, and may not be possible in men with a large resection cavity. Patients need to have acceptable anaesthetic risks for general or spinal anaesthesia and not have a bleeding disorder or current therapy with blood thinning agents.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

“…If, after the planning process, it becomes clear that this dose is not going to be deliverable due to misplacement or movement of seeds causing a low dose region, this could be rectified by either repeat seed insertion or an EBRT boost. 8 In HDR brachytherapy, a remote afterloading system using Ir 192 is used. Flexible, hollow afterloading applicator needles (usually 15-20 per patient) are positioned directly into the prostate gland through a perineal template using direct transrectal ultrasound guidance under general or spinal anaesthetic (Figure 3).…”

Section: Insertion Techniquementioning

confidence: 99%

Brachytherapy in prostate cancer: techniques and clinical outcomes

Prentice¹,

Nei²,

Lewis³

et al. 2018

Trends Urol & Men's Health

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“…Both modalities can be used either as a monotherapy or as a boost with EBRT. Monotherapies are generally used for low- and intermediate-risk PC, whereas combined therapy usually is used for intermediate- and high-risk PC [66]. The logistics are the main advantage of LDR: you can implant it with small shields, whereas HDR is applied in a specialised shielded room for radioprotection issue.…”

Section: Brachytherapymentioning

confidence: 99%

Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know?

Vanneste

Limbergen

Lin

et al. 2016

BioMed Research International

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Radiotherapy (RT) for prostate cancer (PC) has steadily evolved over the last decades, with improving biochemical disease-free survival. Recently population based research also revealed an association between overall survival and doses ≥ 75.6 Gray (Gy) in men with intermediate- and high-risk PC. Examples of improved RT techniques are image-guided RT, intensity-modulated RT, volumetric modulated arc therapy, and stereotactic ablative body RT, which could facilitate further dose escalation. Brachytherapy is an internal form of RT that also developed substantially. New devices such as rectum spacers and balloons have been developed to spare rectal structures. Newer techniques like protons and carbon ions have the intrinsic characteristics maximising the dose on the tumour while minimising the effect on the surrounding healthy tissue, but clinical data are needed for confirmation in randomised phase III trials. Furthermore, it provides an overview of an important discussion issue in PC treatment between urologists and radiation oncologists: the comparison between radical prostatectomy and RT. Current literature reveals that all possible treatment modalities have the same cure rate, but a different toxicity pattern. We recommend proposing the possible different treatment modalities with their own advantages and side-effects to the individual patient. Clinicians and patients should make treatment decisions together (shared decision-making) while using patient decision aids.

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Brachytherapy: state‐of‐the‐art radiotherapy in prostate cancer

Cited by 25 publications

References 70 publications

Feasibility for active surveillance in biopsy Gleason 3 + 4 prostate cancer: an Australian radical prostatectomy cohort

Feasibility for active surveillance in biopsy Gleason 3 + 4 prostate cancer: an Australian radical prostatectomy cohort

Brachytherapy in prostate cancer: techniques and clinical outcomes

Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know?

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