Randomised trial of external-beam radiotherapy alone or with high-dose-rate brachytherapy for prostate cancer: mature 12-year results
Mature results from randomised trials of external beam radiotherapy (EBRT) show that biochemical control of disease improves with increasing radiation dose [1 –4]. High-dose-rate afterloading brachytherapy (HDR-BT) can deliver a high, localised radiation dose to the prostate with excellent biochemical control of disease and has advantages over external beam radiotherapy (EBRT) because of its ability to overcome problems of organ movement, which confound the external beam techniques used [5–7]despite modern image guided approaches.
CONCLUSION: Prostate cancer treatment choices differ substantially between men diagnosed in private and public health services in Victoria. These differences are not explained by disease severity or comorbidity. PMID: 32996611 [PubMed - as supplied by publisher]
CONCLUSION: At 12 years there remains a significant improvement in RFS after EBRT + HDR-BTb; both treatments were equitoxic for severe late urinary and bowel events and urethral strictures. PMID: 33011207 [PubMed - as supplied by publisher]
The use of high-dose rate (HDR) brachytherapy in the treatment of prostate cancer is now well established. According to American Society of Clinical Oncology/Cancer Care Ontario brachytherapy guidelines , HDR- or Low Dose-Rate brachytherapy should be offered as a boost to external beam radiotherapy (EBRT) in eligible intermediate and high-risk patients and may be an option as monotherapy in patients with more favourable disease.
The natural history of radiorecurrent of high-risk prostate cancer (HRPCa) is poorly understood, despite the proportionally higher rates of BCR in this risk group. Treatment HRPCa with external beam radiotherapy (EBRT) plus brachytherapy (BT) boost (EBRT+BT) has been associated with lower rates of BCR, distant metastasis (DM), and PCa-specific mortality (PCSM) compared to EBRT alone. However, it is unclear whether patients who develop BCR following either approach have similar downstream oncologic outcomes.
CONCLUSIONS: In this prematurely closed trial, we observed an unexpected high rate of termination of AS and an increased toxicity related to PSI. Patients hesitated to be randomized in a multi-arm trial. The optimal treatment of low and early-intermediate risk PCa remains unclear. PMID: 32886212 [PubMed - as supplied by publisher]
ConclusionThe single-fraction HDR-BT with EBRT is a safe treatment for quicker recovery of urinary symptoms and QOL. The dose of at-risk organs correlated with toxicities.Secondary abstractSingle-fraction high-dose-rate brachytherapy (HDR-BT) combined with external beam radiotherapy (EBRT) for prostate cancer is a safe treatment allowing for quicker recovery of urinary symptoms and QOL. The dose of at-risk organs correlated with toxicities.
Abstract BACKGROUND AND PURPOSE: Declining prostate brachytherapy utilization has been reported in several studies, despite strong evidence for efficacy and safety compared to alternatives. We sought to evaluate contemporary trends in brachytherapy, external beam radiotherapy (EBRT) and prostatectomy utilization in a publicly funded healthcare system. MATERIALS AND METHODS: Men with localized prostate cancer diagnosed and treated between 2006 and 2017 in Ontario, Canada were identified using administrative data. Men received EBRT, brachytherapy (monotherapy or boost) or prostatectomy as initial definitive man...
Prostate cancer is the most common non-cutaneous malignancy in North American and European men [1 –3]. For those who undergo curative-intent treatment, preferred options for localized prostate cancer include radical prostatectomy, external beam radiotherapy (EBRT) and brachytherapy  either alone or in combination with EBRT. Guidelines from the American Society of Clinical Oncology and Cance r Care Ontario recommend that brachytherapy be considered for the treatment of all appropriate prostate cancer risk categories undergoing definitive management .
CONCLUSIONS: Urethral complications related to prostate RT are seldom an isolated problem and require a substantial amount of urological resources and interventions. PMID: 32701436 [PubMed - as supplied by publisher]
Multiple forms of definitive radiotherapy are acceptable alternatives to more prolonged radiotherapy regimens for men with intermediate-risk prostate cancer (PCa) and can be considered for men with low-risk disease who decline active surveillance. Stereotactic body radiotherapy (SBRT) is an external beam radiotherapy modality in which large radiation doses are delivered over five or fewer fractions. Two forms of brachytherapy -- permanent seed implant low dose rate brachytherapy (LDR-BT) and temporary interstitial implant high dose rate brachytherapy (HDR-BT) -- are also options.