Prostate brachytherapy is among several roughly comparable options for front line treatment of localized prostate cancer available at this time. Unfortunately, there had not been a comparative prospective trial comparing seed implants, brachytherapy, external radiation, robotic prostatectomy, nerve sparing prostatectomy or conventional prostatectomy, proton beam radiotherapy and hormonal manipulation. Retrospective reviews, however, show these options to be similarly effective. A 2008 research summary by the Agency for Healthcare Research and Quality (AHRQ) noted that no randomized controlled trials had compared brachytherapy with other major treatment options for clinically localized prostate cancer. Currently, brachytherapy is widely used but with external beam radiotherapy( EBRT) support. The reason for it is that brachytherapy delivers radiation over very small distances. It does not, for example, get enough radiation to the outer part of the prostate. EBRT treats the areas in which radation distribution from brachytherapy is decreased. High dose approaches and combnations with other treatments may do what ERBT currently does. Whether some patients can avoid EBRT is being investigated.
Agency for Healthcare Research and Quality. Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer. AHRQ: Agency for Healthcare Research and Quality. Available at http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr&ProcessID=9&DocID=79. Accessed January 15, 2009.
Frank SJ, Grimm PD, Sylvester JE, Merrick GS, Davis BJ, Zietman A, et al. Interstitial implant alone or in combination with external beam radiation therapy for intermediate-risk prostate cancer: a survey of practice patterns in the United States. Brachytherapy. Jan-Mar 2007;6(1):2-8.
Grimm P, Billiet I, Bostwick D, Dicker AP, Frank S, Immerzeel J, 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. Feb 2012;109 Suppl 1:22-9. [Medline].
Wattson DA, Chen MH, Moul JW, Moran BJ, Dosoretz DE, Robertson CN, et al. The Number of High-Risk Factors and the Risk of Prostate Cancer-Specific Mortality After Brachytherapy: Implications for Treatment Selection. Int J Radiat Oncol Biol Phys. Jan 31 2012;[Medline].
Yamada Y, Rogers L, Demanes DJ, Morton G, Prestidge BR, Pouliot J, et al. American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy. Jan-Feb 2012;11(1):20-32.
Read the Layperson version here.