Elevate prostate cancer treatment with brachytherapy
Insights from radiation oncologists and physicists.
Unlock the potential of brachytherapy – a game-changing treatment for prostate cancer patients
Alfonso Gomez Iturriaga, MD, PhD from Cruces University Hospital in Bilbao, Spain, explains how this technique stands out from conventional radiation methods, redefining prostate cancer care.
Unprecedented dose precision
Explore why prostate brachytherapy achieves doses previously unattainable with other radiation techniques.
Targeting the Dominant Intraprostatic Lesion (DIL)
Understand how brachytherapy intensifies doses to specific prostate areas while ensuring uniform doses across the rest, minimizing risk to adjacent organs.
Low integral dose to patients
Learn how the internal administration of radiation in brachytherapy minimizes exposure to surrounding healthy tissues, reducing overall radiation impact. Patient selection criteria:
Tumor characteristics
High-risk disease patients benefit most from the dose intensification of brachytherapy.
Patient Factors
Factors like urinary function, IPSS score, and prostate volume guide patient selection, ensuring a positive treatment outcome
Advancing prostate cancer care—A closer look at brachytherapy
Discover a comprehensive exploration of prostate brachytherapy in our article, "Precision and Promise."
Gain insights into the practices at Cruces University Hospital in Bilbao, Spain, where medical experts such as Alfonso Gomez Iturriaga, MD, PhD, and David Büchser MD share valuable perspectives on the precision and patient-centric approaches of prostate brachytherapy. This article offers an informative and educational exploration of brachytherapy's efficacy and patient benefits through real-world case studies and evidence-based discussions. Learn how this therapeutic approach contributes to evolving standards in prostate cancer care. read the full article for in-depth insights into brachytherapy's precision and promise in prostate cancer treatment.
Precision and Promise
Brachytherapy presents many advantages for treating prostate cancer
Prostate cancer is a global health concern, impacting millions of men worldwide. The disease is the most common urological cancer, representing a substantial health burden to the world particularly in developed countries. 1 In 2020, prostate cancer contributed to 14.1 percent and 6.8 percent of all cancer cases and deaths among males. 2 This article presents the advantages of prostate brachytherapy, a modality that has demonstrated a high degree of safety and effectiveness when used as a monotherapy or in conjunction with external beam radiation therapy (EBRT). 3-4
What is prostate brachytherapy?
Brachytherapy is a form of internal radiation therapy designed to target cancer cells directly within affected organs or tissues. A radiation-emitting source is introduced into the body that irradiates and destroys cancer cells. Two types of brachytherapy are used to treat prostate cancer:
Permanent seeds or low dose rate (LDR) brachytherapy.
This form of brachytherapy involves placing small radiation-emitting “seeds” inside the prostate. The seeds emit a specific amount of radiation over a period of months and then cease discharging radiation.
Temporary or high dose rate (HDR) brachytherapy.
HDR is also known as temporary brachytherapy because it delivers a high dose of radiation over a short period of time. A clinician inserts needles into the prostate and then removes the needles, leaving the catheters in place. A radiation-emitting source then moves inside the catheters to a predetermined distance and “dwells” at a location inside the prostate, emitting radiation for five to 15 minutes, after which the source is withdrawn. This provides a concentrated dose of radiation over a short period of time.
Who is eligible for brachytherapy?
Patients diagnosed with prostate cancer may be offered brachytherapy, either LDR or HDR, for several clinical indications:
- Brachytherapy may be used alone for low to favorable intermediate risk prostate cancer patients (intraprostatic disease, Gleason score 6 to 3+4, with low PSA at diagnosis). In this indication, brachytherapy is highly effective in treating prostate cancer. A 2018 study tracked outcomes for 757 people who received brachytherapy for localized prostate cancer between 1990 and 2006. The study found a 17-year prostate specific survival (PsS) rate of 97 percent. 5
- Brachytherapy may be used in combination with EBRT for treating patients presenting with unfavorable intermediate, high and very high-risk prostate cancer (Gleason score 4+3 and higher). According to the American Cancer Society, the addition of brachytherapy to EBRT improves outcomes compared to EBRT alone. Brachytherapy increases the nine-year survival rate from 62 percent to 83 percent for those with immediate to high-risk cancer. 6 The association of EBRT with brachytherapy has shown superior efficacy compared to EBRT alone or even surgery in several recently published series confirming the key role of brachytherapy for these patients. 7-9
- Brachytherapy, especially HDR, may be offered as a salvage intraprostatic treatment for patients relapsing years after a first treatment with EBRT or brachy. Men treated primarily with EBRT or brachytherapy may relapse years after their first treatment, with the disease recurring in the prostate. In this case, if the patient still has a long life expectancy, a salvage treatment may be offered. Surgery, high-intensity ultrasound or cryotherapy are currently proposed in this setting, but results based on a large series of patients have shown that HDR brachytherapy is probably the most reasonable salvage choice because of the lowest risk of side effects. 10-11
Metastatic Advanced Prostate Cancer
Metastatic Advanced Prostate Cancer has spread from the prostate to other parts of the body, most commonly to the bones and lymph nodes. Depending on where the cancer has spread, advanced prostate cancer can cause symptoms, such as fatigue, bone pain, and difficulty urinating. Treatments such as hormones and chemotherapy can help keep the disease under control and to manage symptoms. Patients may be offered EBRT as part of their first treatment. Research has found that combining EBRT with hormone therapy or chemotherapy can help some patients with metastatic prostate cancer live longer. Radiotherapy can also be used to relieve symptoms such as pain in bone metastases. Brachytherapy is generally not used for advanced prostate cancer that has spread to the lymph nodes or distant areas of the body.
The advantages of brachytherapy for prostate cancer
Prostate brachytherapy presents numerous advantages, serving as an effective and patient-centric treatment modality. Excellent long-term results have been published for all risk groups. 12 Physicians have successfully used brachytherapy to treat prostate cancer for many decades. Modern state-of-the-art technologies are used to help healthcare professionals deliver brachytherapy with a high level of precision. Brachytherapy is recognized as a standard treatment alongside surgery and EBRT. 13-14 In high-risk prostate cancer – disease diagnosed in more advanced stages – optimization of local control is critical.
- Clinically proven to be highly effective
15-16
Many studies show that patients remain cancer-free after brachytherapy. Below, we present clinical studies and long-term follow-up data supporting the efficacy and safety of brachytherapy in prostate cancer treatment. - Precision in treatment delivery
By targeting the area where the brachytherapy needles are placed, radiation is given in high doses directly to the prostate with few or no side effects. This precise targeting leads to higher therapeutic ratios, thus maximizing cancer control. - Reduced risk of unnecessary damage to surrounding healthy
tissues and organs
Brachytherapy’s main benefit is limiting radiation exposure to surrounding areas. Healthy structures around the prostate (bladder, rectum, urethra) receive almost no radiation. - Radiation dose customization
The ability to customize radiation doses based on tumor characteristics enables the creation of personalized treatment plans that optimize outcomes while minimizing side effects. - Enhanced patient experience
Patients undergoing brachytherapy often report less pain and discomfort during and after treatment, contributing to a better overall experience. - Minimized side effects
The accurate and targeted nature of LDR and HDR brachytherapy reduces the risk of side effects. 15-16 Avoiding radiation to surrounding critical organs and tissues decreases side effects, thereby contributing to better quality of life. - Shorter treatment times and recovery periods
15-16
Brachytherapy is commonly given on an outpatient basis, encompassing daily treatment sessions during an inpatient stay of a few days. Patients can usually get back to their normal activities within a week. - Minimally invasive
15-16
As a minimally invasive technique, brachytherapy avoids the need for extensive surgery, often making it a desirable alternative to prostatectomy.
Evidence-based outcomes demonstrate the effectiveness of prostate brachytherapy
In this data-driven section, we present compelling clinical studies and long-term follow-up data supporting the efficacy and safety of brachytherapy in prostate cancer treatment.
Several studies show the clinical benefits of HDR boost and salvage
The association of EBRT with brachytherapy has shown superior efficacy compared to EBRT alone or even surgery in several recently published series confirming the key role of brachytherapy for these patients. 7-9
Brachytherapy, especially HDR, may be offered as a salvage intraprostatic treatment for patients relapsing years after a first treatment with EBRT or brachytherapy. Patients treated primarily with EBRT or brachytherapy may relapse years after their first treatment, with the disease recurring in the prostate. In this case, if the patient still has a long life expectancy, a salvage treatment may be offered. Surgery, high-intensity ultrasound or cryotherapy are currently proposed in this setting, but results based on a large series of patients have shown that HDR brachytherapy is probably the most reasonable salvage choice because of the lowest risk of side effects. 10-11
A 718-patient study from Germany reported that HDR brachytherapy
ensures an excellent outcome:
After eight years, biochemical control in prostate cancer was 90
percent, and metastasis-free survival was 97 percent (picture 1).
Biochemical control means that 90 percent of patients were free from
increased PSA (biochemical recurrence) after eight years.
Metastasis-free survival means that 97 percent of patients had no
metastases after eight years.
17
Results of the UK trial comparing external beam radiation therapy (EBRT) alone and EBRT + high dose rate (HDR) brachytherapy shows advantages in relapse-free survival when brachytherapy is added to the treatment: 55% and 71% at six years and 27% and 48% at 12 years. When brachytherapy was added to the treatment, 71% of patients weren’t diagnosed with cancer six years post-treatment, and 48% weren’t diagnosed with experience cancer 12 years post-treatment. 18
The American Brachytherapy Society, with expert input and an extensive literature review, recommends HDR brachytherapy for localized prostate cancer. Research supports this, showing biochemical control rates of 85-100%, 81-100%, and 43-93% for low-, intermediate-, and high-risk cases. HDR offers excellent outcomes with low morbidity, making it a promising primary and salvage treatment choice. 19
Another study highlights excellent outcomes of LDR brachytherapy for intermediate-risk prostate cancer patients, including unfavorable intermediate-risk cases, treated with BED ≥ 200 Gy radiotherapy. 20
Another study looked into the long-term outcome of early-stage prostate cancer treated with brachytherapy after a mean follow-up of seven years. The biochemical recurrence-free survival rate for low-, intermediate- and high-risk patients four to seven years post-brachytherapy ranged from 85%-96%, 74%-97%, and 38%-82%, respectively. 21
Patient and clinical perspectives
Patient insights
Erman
Prostate cancer patient
Brachytherapy gives Erman hope to return to a normal life
Erman, a resident of Basilicata, Italy received some disturbing news from a blood test. His physician told him his PSA (prostate-specific antigen) level was 13.0; the normal range is between 1.0 and 1.5 ng/ml.
“She immediately sent me to the hospital to see a urologist,” says Erman, a married father of two children and two grandchildren. “The doctor who examined me ordered a biopsy of my prostate right away. When the result arrived, my whole world collapsed.”
Erman was diagnosed with prostate cancer and, worse, the surgeon told him he told him he would be unable to surgically remove his prostate, because it was likely he wouldn’t survive the operation.
“You can imagine how I felt,” Erman says. “However, a second doctor – an interventional radiation oncologist – gave me some hope. He would perform a brachytherapy procedure, something I’d never heard of before then.”
After brachytherapy, the physician assured him that everything had gone well.
“I was reborn,” Erman recalls. “A few days after the procedure I already felt better, apart from some difficulty urinating. But mostly I felt relaxed and I was happy to have my normal life back.
“I want to encourage anyone who suffers from the same illness as me to look into brachytherapy, because, in my opinion, it is the least invasive, according to my research on the subject,” he adds. “You will come out of it as happy as I am.”
Clinician insights
Alfonso Gómez Iturriaga, MD, PhD
Radiation Oncologist
Associate Professor of Radiation Oncology
Cruces University Hospital, Bilbao, Spain
Brachytherapy a highly targeted treatment for intermediate to high-risk disease
Physicians at Cruces University Hospital perform two to three HDR brachytherapy procedures each week. HDR brachytherapy and EBRT are preferred in high-risk disease or recurrence cases. Prof. Gómez Iturriaga advocates brachytherapy as a treatment for prostate cancer.
“Brachytherapy excels in delivering high doses of radiation specifically to the prostate while sparing healthy tissues,” he says. “In addition, preserving the prostate – keeping it intact – is crucial for the patient’s quality of life. Brachytherapy provides a high chance of curing the disease while maintaining urinary, bowel, and sexual function.”
In terms of patient selection for HDR brachytherapy, Prof. Gómez Iturriaga explains that it is based on tumor and individual characteristics and generally more beneficial for patients with intermediate to high-risk disease.
“These are the patients that benefit more from the dose intensification associated with brachytherapy,” he says. “Patient characteristics are also quite important – whether the patient can tolerate the treatment. One of these characteristics is the patient’s degree of difficulty in urinating and their IPSS score. In terms of prostate volume, patients with prostates larger than 60 cc’s with poor urinary function may have more side effects than others. Overall, we try to select patients with a high risk of disease and with favorable indicators that brachytherapy would be beneficial.”
Real-time imaging in HDR brachytherapy is a game-changer, Prof. Gómez Iturriaga adds.
“It simplifies the procedure, reduces the time needed, and maintains patient comfort by allowing all steps to be performed in the operating room without moving the patient,” he explains. “We deliver the treatment, remove the needles and the entire procedure is finished in one-and-a-half to two hours.”
Despite the promising outcomes of prostate brachytherapy, Prof. Gómez Iturriaga notes that brachytherapy still is underutilized in Spain. He highlights the need to raise awareness among urologists regarding the procedure's ease and effectiveness.
“Some urologists may hesitate to recommend brachytherapy due to misconceptions about its side effects and difficulty,” he says. “Overcoming this challenge involves educating them about the procedure's modern, efficient, and low-risk nature.”
Prof. Gómez Iturriaga adds that setting up a prostate brachytherapy program is relatively straightforward if the institution already conducts other forms of brachytherapy. It requires appropriate software, ultrasound equipment, and training. Observerships in experienced centers can help those new to brachytherapy get started.
He stressed that the accuracy, conformity, and clinical data supporting brachytherapy make it a compelling choice. The future may involve combining new imaging techniques with the precision of brachytherapy, high radiation doses, and brachytherapy combined with SBRT.
David Büchser, MD
Radiation oncologist
Cruces University Hospital, Bilbao, Spain
Delivering dose to the disease, avoiding healthy tissues a hallmark of brachytherapy
David Büchser, MD, who with his team performs two to three prostate brachytherapy procedures weekly, highlights prostate brachytherapy's precision, effectiveness, and patient-centered approach, emphasizing its value in treating localized prostate cancer.
“Prostate brachytherapy is the radiation technique that is the most precise by far,” he says. “It allows extreme dose escalation within the prostate while preserving the surrounding healthy tissues from high radiation doses. That means you maximize the chances of tumor control while reducing the rates of acute and late toxicities. Therefore, many patients with localized prostate cancer can benefit from LDR or HDR prostate brachytherapy.”
David Büchser, MD, emphasizes real-time imaging's significance, as it allows the procedure to be performed with the patient in position, improving treatment reliability.
“Without real-time imaging, after you perform the implant you would need to reposition the patient’s legs to transport him out of the OR and to the CT or MR suite for imaging, then return the patient to the treatment room to complete the whole dosimetry,” he says. “All of this replacing and moving the patient adds uncertainty to the process. Real-time imaging eliminates those uncertainties and allows you to perform the whole procedure with the patient in position and without movement, resulting in a very solid protocol.”
When establishing a real-time HDR program, it is critical that clinicians be well-versed in transrectal ultrasound and have a solid understanding of HDR prostate brachytherapy dosimetry, according to David Büchser, MD.
“If a center has no experience in prostate brachytherapy, a staff member with experience in transrectal ultrasound and the placement of needles through the peritoneum would be very helpful,” he observes.
He encourages peers to consider starting a prostate brachytherapy program, especially those already using external beam radiation therapy for prostate cancer.
“Prostate brachytherapy allows for dose escalation within the prostate, thereby enhancing disease control without compromising patient functionality,” David Büchser, MD, says.
David Büchser, MD, recognizes the ongoing challenge of raising awareness among colleagues about the value of prostate brachytherapy.
“Despite the mountain of evidence of the benefit of prostate brachytherapy, we will have to strive to make clinicians see that the modality plays a key role in the management of patients with localized prostate cancer,” he says. “While external beam radiotherapy developments may seem appealing, we have to make an effort to demonstrate how prostate brachytherapy can help us achieve better outcomes, while preserving patient functionality, making it an attractive treatment option.”
Juan Carlos Moscarei, MD
Radiation oncologist
Cruces University Hospital, Bilbao, Spain
As a professional discipline, brachytherapy offers clinicians a rich career experience
In exploring medical specialties during his training, Dr. Moscarei saw radiation oncology as a discipline that would offer a wide range of opportunities.
“It had everything I was looking for in a specialty,” he says. “It is a decisive treatment modality and the daily work can be quite varied – there’s the clinic, there’s contouring and imaging, and, above all, the chance to have patient contact. Plus, brachytherapy is an ‘artisan technique’ that depends on skill. All of this seemed very attractive to me so I decided I would like to practice brachytherapy.”
Dr. Moscarei derives the most satisfaction from the opportunity to help patients in the best possible way.
“The benefit that brachytherapy brings to patients is mainly dosimetry,” he explains. “This allows dose escalation without increasing toxicity to organs-at-risk, in turn, enabling more curative treatments or therapy that is less toxic or with shorter treatment times.
“To new physicians who are undecided,” Dr. Moscarei continues, “I would say that brachytherapy is a technique that requires a desirable level of craftsmanship and one that enables more complete and greater diversity of treatments.”
Although he has been training for only a short time, he still remembers the first case in which he introduced the brachytherapy needles.
“I recall that when I saw him 48 hours later in consultation, the patient was asymptomatic and maintaining his quality of life and that gave me a lot of satisfaction,” he says. “Subsequently, he is doing well and that also makes me very happy with the treatment.”
José María Espinosa, PhD
Medical physicist
Cruces University Hospital, Bilbao, Spain
Real-time ultrasound imaging reduces uncertainty during brachytherapy
In planning prostate brachytherapy, there is no substitution for real-time imaging, according to Dr. Espinosa, who has been using ultrasound with the patient in the treatment position.
“We believe that it is a fundamental advantage to use real-time ultrasound to reduce geometric uncertainty,” he says. “We first carry out a pre-plan using ultrasound, so that we will be able to best decide where to put the brachytherapy needles – repositioning them if necessary and thus obtaining a treatment appropriate to the patient’s geometry.”
The next evolution of the prostate brachytherapy Dr. Espinosa’s team has been performing for the last 10 years will be the elimination of manual steps throughout the entire treatment, he predicts.
“In particular, if we could implement a system that identifies all the treatment tubes – just as it exists in gynecological brachytherapy in which the first three tubes are identified – we would not have any manual errors in tube placement,” Dr. Espinosa explains. “If an electronic system connected to the software could be installed in the needle insertion grid to inform you about which needle to select we believe that manual errors could be avoided.”
He adds that an acceleration of the speed of the Monte Carlo dose calculation – which would account for tissue inhomogeneities or the presence of air – and an improvement of the fusion algorithms to help ascertain focal prostate areas that could receive a higher dose, could also bring prostate brachytherapy to the next level.
Conclusion
Brachytherapy excels in precision, effectiveness, and patient-centered care for prostate cancer treatment. It precisely targets prostate tumors, maximizing cancer control while minimizing side effects through tailored radiation doses. Patients experience minimal pain and discomfort, and benefit from shorter treatment times, faster recovery, and fewer side effects.
Although brachytherapy’s adoption worldwide is still relatively low – necessitating increased awareness and education among radiation oncologists and urologist – the modality offers hope to prostate cancer patients by virtue of its many benefits. Clinical evidence consistently demonstrates its efficacy and safety, with high long-term success rates. 22-25
References
1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics
2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide
for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021
May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4.
PMID: 33538338.
2. https://gco.iarc.fr/today/home
3. Behmueller M, Tselis N, Zamboglou N, et al. High-dose-rate
brachytherapy as monotherapy for low- and intermediate-risk
prostate cancer. Oncological outcomes after a median 15-year
follow-up. Front Oncol. 2021 Dec 2;11:770959. doi:
10.3389/fonc.2021.770959. PMID: 34926278; PMCID: PMC8674679.
4. Hjälm-Eriksson M, Nilsson S, Brandberg Y, et. al. High rate
of local control and cure at 10 years after treatment of
prostate cancer with external beam radiotherapy and
high-dose-rate brachytherapy: a single centre experience. Acta
Oncol. 2021 Oct;60(10):1301-1307. doi:
10.1080/0284186X.2021.1953706. Epub 2021 Sep 9. PMID:
34498986.
5. Lazarev S, Thompson MR, Stone NN, et al. Low-dose-rate
brachytherapy for prostate cancer: outcomes at >10 years of
follow-up. BJU Int. 2018 May;121(5):781-790. doi:
10.1111/bju.14122 . Epub 2018 Jan 30. PMID: 29319928.
6. Rodda S, Morris WJ, Hamm J, et al. ASCENDE-RT: An analysis of
health-related quality of life for a randomized trial comparing
low-dose-rate brachytherapy boost with dose-escalated external
beam boost for high- and intermediate-risk prostate cancer. Int
J Radiat Oncol Biol Phys. 2017;98(3)581-589.
7. Kishan AU, Cook RR, Ciezki JP, et al. Radical prostatectomy,
external beam radiotherapy, or external beam radiotherapy with
brachytherapy boost and disease progression and mortality in
patients with Gleason score 9-10 prostate cancer. JAMA. 2018 Mar
6;319(9):896-905. doi: 10.1001/jama.2018.0587. PMID: 29509865;
PMCID: PMC5885899.
8. Tilki D, Chen MH, Wu J, et al. Surgery vs radiotherapy in the
management of biopsy Gleason score 9-10 prostate cancer and the
risk of mortality. JAMA Oncol. 2019 Feb 1;5(2):213-220. doi:
10.1001/jamaoncol.2018.4836. PMID: 30452521; PMCID:
PMC6439553.
9. Kishan AU, Karnes RJ, Romero T, et al. Comparison of
multimodal therapies and outcomes among patients with high-risk
prostate cancer with adverse clinicopathologic features. JAMA
Netw Open. 2021 Jul 1;4(7):e2115312. doi:
10.1001/jamanetworkopen.2021.15312. PMID: 34196715; PMCID:
PMC8251338.
10. Valle LF, Lehrer EJ, Markovic D, et al. A systematic review
and meta-analysis of local salvage therapies after radiotherapy
for prostate cancer (MASTER). Eur Urol. 2021 Sep;80(3):280-292.
doi: 10.1016/j.eururo.2020.11.010. Epub 2020 Dec 11. PMID:
33309278; PMCID: PMC10262981.
11. Kissel M, Pounou A, Ka K, Alexis A, et al. Efficacy and
toxicity following salvage high-dose-rate brachytherapy for
locally recurrent prostate cancer after radiotherapy.
Brachytherapy. 2022 Jul-Aug;21(4):424-434. doi:
10.1016/j.brachy.2022.01.005. Epub 2022 Mar 21. PMID:
35331666.
12. American Brachytherapy Society. Prostate Brachytherapy –
LDR.
https://www.americanbrachytherapy.org/resources/for-professionals/current-applications-of-brachytherapy/prostate-brachytherapy-ldr/#:~:text=Prostate%20Brachytherapy%20%2D%20Indications&text=For%20most%20men%20with%20high,9%2D12%20months%20is%20appropriate.
13. Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG
Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and
Local Treatment with Curative Intent. European Urology, Volume
71, Issue 4, 2017, Pages 618-629, ISSN 0302-2838,
https://doi.org/10.1016/j.eururo.2016.08.003.
14. Cornford P, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG
Guidelines on Prostate Cancer. Part II: Treatment of Relapsing,
Metastatic, and Castration-Resistant Prostate Cancer. European
Urology, Volume 71, Issue 4, 2017, Pages 630-642, ISSN
0302-2838, https://doi.org/10.1016/j.eururo.2016.08.002.
15. Grimm P, Billiet I, Bostwick D, et al. Comparative analysis
of prostate-specific antigen free survival outcomes for patients
with low, intermediate and high risk prostate cancer treatment
by radical therapy. Results from the Prostate Cancer Results
Study Group. BJU Int. 2012 Feb;109 Suppl 1:22-9. doi:
10.1111/j.1464-410X.2011.10827.x. PMID: 22239226.
16. Morton GC at al. Clin Oncol. 2020;32(3):163-9.
https://www.clinicaloncologyonline.net/article/S09366555(19)30491-1/fulltext
17. Zamboglou N, Tselis N, Baltas D, et al. High-dose-rate
interstitial brachytherapy as monotherapy for clinically
localized prostate cancer: treatment evolution and mature
results. Int J Radiat Oncol Biol Phys. 2013 Mar 1;85(3):672-8.
doi: 10.1016/j.ijrobp.2012.07.004. Epub 2012 Aug 25. PMID:
22929859.
18. Hoskin, PJ, Rojas, AM, Ostler, PJ, et al. Randomised trial
of external-beam radiotherapy alone or with high-dose-rate
brachytherapy for prostate cancer: Mature 12-year results,
Radiotherapy and Oncology, Volume 154, 2021, Pages 214-219, ISSN
0167-8140, https://doi.org/10.1016/j.radonc.2020.09.047.
19. Yamada Y, Rogers L, Demanes DJ, et al. American
Brachytherapy Society consensus guidelines for high-dose-rate
prostate brachytherapy. Brachytherapy. 2012 Jan-Feb;11(1):20-32.
doi: 10.1016/j.brachy.2011.09.008. PMID: 22265435.
20. Okamoto K, Okuyama K, Kohno N, et al. Clinical outcomes of
low-dose-rate brachytherapy based radiotherapy for intermediate
risk prostate cancer. J Contemp Brachytherapy. 2020
Feb;12(1):6-11. doi: 10.5114/jcb.2020.92405. Epub 2020 Feb 28.
PMID: 32190064; PMCID: PMC7073334.
21. Yan W, Chen J, Zhou Y, et al. Long-term outcome of early
stage prostate cancer treated with brachytherapy analysis after
a mean follow-up of 7 years. Springerplus. 2014 Jul 15;3:357.
doi: 10.1186/2193-1801-3-357. PMID: 25089248; PMCID:
PMC4117862.
22. Wegener E, Samuels J, Sidhom M, et al. Virtual HDR boost for
prostate cancer: rebooting a classic treatment using modern
tech. Cancers (Basel). 2023 Mar 28;15(7):2018. doi:
10.3390/cancers15072018. PMID: 37046680; PMCID: PMC10093761.
23. Crook, J Marbán M, Batchelar, D. HDR Prostate Brachytherapy,
Seminars in Radiation Oncology, Volume 30, Issue 1,
24. 2020, Pages 49-60, ISSN 1053-4296,
https://doi.org/10.1016/j.semradonc.2019.08.003.
(https://www.sciencedirect.com/science/article/pii/S1053429619300578)
25. Zhang H, Kang S, Ali N, et al. Building a high-dose-rate
prostate brachytherapy program with real-time ultrasound-based
planning: Initial safety, quality, and outcome results. Open
Access: Published: February 21, 2020. DOI:
https://doi.org/10.1016/j.adro.2020.02.002.
How brachytherapy transforms prostate cancer treatment
Watch exclusive videos. Click below to explore.
3 key advantages
Brachytherapy over other radiation treatments and discusses patient selection criteria.
Ready to implement Prostate Brachytherapy in your practice?
Book a meeting with our specialists to help you get started.
Unlock exclusive content
Sign up and gain access to insights from radiation oncologists and physicists.