Skip to main content

Advertisement

SpringerLink
Log in

Update on Prostate Brachytherapy: Long-term Outcomes and Treatment-related Morbidity

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Current research in prostate brachytherapy focuses on five key concepts covered in this review. Transrectal ultrasound-guided prostate brachytherapy assisted by intraoperative treatment planning is the most advanced form of image-guided radiation delivery. Prostate brachytherapy alone for low-risk prostate cancer achieves lower prostate-specific antigen (PSA) nadirs than intensity-modulated radiotherapy (IMRT) or protons while maintaining durable biochemical control in about 90% of patients without late failures seen in surgically treated patients. As an organ-conserving treatment option, seed implant results in a lower rate of erectile dysfunction and urinary incontinence than surgery that has been validated in several recent prospective studies. Combined IMRT and seed implant has emerged as a rational and highly effective approach to radiation-dose escalation for intermediate- and high-risk prostate cancer. Preliminary results suggest that seed implantation may play a role in improving outcomes for historically poor-prognosis locally advanced and recurrent prostate cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mohler J, Bahnson RR, Boston B, et al. NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw. 2010;8:162–200.

    PubMed  CAS  Google Scholar 

  2. Walsh PC, DeWeese TL, Eisenberger MA. Clinical practice. Localized prostate cancer. N Engl J Med. 2007;357:2696–705.

    Article  PubMed  CAS  Google Scholar 

  3. Stock RG, Stone NN. Current topics in the treatment of prostate cancer with low-dose-rate brachytherapy. Urol Clin North Am. 2010;37:83–96. Table of Contents.

    Article  PubMed  Google Scholar 

  4. Timmerman RD, Xing L. Image-guided and adaptive radiation therapy. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2010.

    Google Scholar 

  5. Holm HH, Juul N, Pedersen JF, et al. Transperineal 125iodine seed implantation in prostatic cancer guided by transrectal ultrasonography. J Urol. 1983;130:283–6.

    PubMed  CAS  Google Scholar 

  6. Stock RG, Stone NN, Wesson MF, DeWyngaert JK. A modified technique allowing interactive ultrasound-guided three-dimensional transperineal prostate implantation. Int J Radiat Oncol Biol Phys. 1995;32:219–25.

    PubMed  CAS  Google Scholar 

  7. Sylvester JE, Grimm PD, Wong J, et al. Fifteen-year biochemical relapse-free survival, cause-specific survival, and overall survival following i(125) prostate brachytherapy in clinically localized prostate cancer: Seattle experience. Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print].

  8. Reed DR, Wallner KE, Merrick GS, et al. A prospective randomized comparison of stranded vs. Loose 125i seeds for prostate brachytherapy. Brachytherapy. 2007;6:129–34.

    Article  PubMed  Google Scholar 

  9. Murphy MK, Piper RK, Greenwood LR, et al. Evaluation of the new cesium-131 seed for use in low-energy x-ray brachytherapy. Med Phys. 2004;31:1529–38.

    Article  PubMed  CAS  Google Scholar 

  10. Tomaszewski JJ, Smaldone MC, Makaroun S, et al. Cesium 131 versus iodine 125 implants for prostate cancer: evaluation of early psa response. Can J Urol. 2010;17:5360–4.

    PubMed  Google Scholar 

  11. Frank SJ, Stafford RJ, Bankson JA, et al. A novel MRI marker for prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2008;71:5–8.

    Article  PubMed  Google Scholar 

  12. Adam Cunha J, Hsu IC, Pouliot J, et al. Toward adaptive stereotactic robotic brachytherapy for prostate cancer: demonstration of an adaptive workflow incorporating inverse planning and an MR stealth robot. Minim Invasive Ther Allied Technol. 2010;19:189–202.

    Article  PubMed  Google Scholar 

  13. Lee WR, deGuzman AF, Bare RL, et al. Postimplant analysis of transperineal interstitial permanent prostate brachytherapy: evidence for a learning curve in the first year at a single institution. Int J Radiat Oncol Biol Phys. 2000;46:83–8.

    Article  PubMed  CAS  Google Scholar 

  14. Potters L, Calugaru E, Jassal A, Presser J. Is there a role for postimplant dosimetry after real-time dynamic permanent prostate brachytherapy? Int J Radiat Oncol Biol Phys. 2006;65:1014–9.

    Article  PubMed  Google Scholar 

  15. Wilt TJ, MacDonald R, Rutks I, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148:435–48.

    PubMed  Google Scholar 

  16. Taira AV, Merrick GS, Butler WM, et al. Long-term outcome for clinically localized prostate cancer treated with permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys. 2010 [Epub ahead of print].

  17. Stone NN, Stone MM, Rosenstein BS, et al. Influence of pretreatment and treatment factors on intermediate to long-term outcome after prostate brachytherapy. J Urol. 2011;185:495–500.

    Article  PubMed  Google Scholar 

  18. Potters L, Morgenstern C, Calugaru E, et al. 12-year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urol. 2008;179:S20–4.

    Article  PubMed  Google Scholar 

  19. D’Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280:969–74.

    Article  PubMed  Google Scholar 

  20. Stock RG, Cesaretti JA, Stone NN. Disease-specific survival following the brachytherapy management of prostate cancer. Int J Radiat Oncol Biol Phys. 2006;64:810–6.

    Article  PubMed  Google Scholar 

  21. Stock RG, Cesaretti JA, Unger P, Stone NN. Distant and local recurrence in patients with biochemical failure after prostate brachytherapy. Brachytherapy. 2008;7:217–22.

    Article  PubMed  Google Scholar 

  22. •• Ahove DA, Hoffman KE, Hu JC, et al. Which patients with undetectable psa levels 5 years after radical prostatectomy are still at risk of recurrence?—implications for a risk-adapted follow-up strategy. Urology 2010;76:1201–5. This is an important retrospective study describing the risk of late biochemical failure in patients treated with radical prostatectomy.

    Article  PubMed  Google Scholar 

  23. Jabbari S, Weinberg VK, Shinohara K, et al. Equivalent biochemical control and improved prostate-specific antigen nadir after permanent prostate seed implant brachytherapy versus high-dose three-dimensional conformal radiotherapy and high-dose conformal proton beam radiotherapy boost. Int J Radiat Oncol Biol Phys. 2010;76:36–42.

    Article  PubMed  CAS  Google Scholar 

  24. Pickett B, Kurhanewicz J, Pouliot J, et al. Three-dimensional conformal external beam radiotherapy compared with permanent prostate implantation in low-risk prostate cancer based on endorectal magnetic resonance spectroscopy imaging and prostate-specific antigen level. Int J Radiat Oncol Biol Phys. 2006;65:65–72.

    Article  PubMed  CAS  Google Scholar 

  25. Wilson LS, Tesoro R, Elkin EP, et al. Cumulative cost pattern comparison of prostate cancer treatments. Cancer. 2007;109:518–27.

    Article  PubMed  Google Scholar 

  26. Konski A, Speier W, Hanlon A, Beck JR, Pollack A. Is proton beam therapy cost effective in the treatment of adenocarcinoma of the prostate? J Clin Oncol. 2007;25:3603–8.

    Article  PubMed  Google Scholar 

  27. Robinson JW, Moritz S, Fung T. Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma. Int J Radiat Oncol Biol Phys. 2002;54:1063–8.

    Article  PubMed  Google Scholar 

  28. •• Sanda MG, Dunn RL, Michalski J, et al.: Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358:1250–61. This large prospective quality-of-life analysis demonstrated that although patients in the prostatectomy group were younger and had a higher baseline sexual function score, surgically treated patients had a much larger decline in sexual function at 2 years than patients treated with brachytherapy or EBRT.

    Article  PubMed  CAS  Google Scholar 

  29. Pardo Y, Guedea F, Aguilo F, et al. Quality-of-life impact of primary treatments for localized prostate cancer in patients without hormonal treatment. J Clin Oncol. 2010;28:4687–96.

    Article  PubMed  Google Scholar 

  30. Gore JL, Kwan L, Lee SP, Reiter RE, Litwin MS. Survivorship beyond convalescence: 48-month quality-of-life outcomes after treatment for localized prostate cancer. J Natl Cancer Inst. 2009;101:888–92.

    Article  PubMed  Google Scholar 

  31. Jani AB, Hellman S. Early prostate cancer: clinical decision-making. Lancet. 2003;361:1045–53.

    Article  PubMed  Google Scholar 

  32. Kuban DA, Tucker SL, Dong L, et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70:67–74.

    Article  PubMed  Google Scholar 

  33. Zietman AL, Bae K, Slater JD, et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95–09. J Clin Oncol. 2010;28:1106–11.

    Article  PubMed  Google Scholar 

  34. Kestin L, Goldstein N, Vicini F, et al. Treatment of prostate cancer with radiotherapy: should the entire seminal vesicles be included in the clinical target volume? Int J Radiat Oncol Biol Phys. 2002;54:686–97.

    Article  PubMed  Google Scholar 

  35. Davis BJ, Pisansky TM, Wilson TM, et al. The radial distance of extraprostatic extension of prostate carcinoma: implications for prostate brachytherapy. Cancer. 1999;85:2630–7.

    Article  PubMed  CAS  Google Scholar 

  36. Crook J, Patil N, Ma C, McLean M, Borg J. Magnetic resonance imaging-defined treatment margins in iodine-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2010;77:1079–84.

    Article  PubMed  Google Scholar 

  37. Ho AY, Burri RJ, Jennings GT, et al. Is seminal vesicle implantation with permanent sources possible? A dose-volume histogram analysis in patients undergoing combined 103pd implantation and external beam radiation for t3c prostate cancer. Brachytherapy. 2007;6:38–43.

    Article  PubMed  Google Scholar 

  38. • Sathya JR, Davis IR, Julian JA, et al.: Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol. 2005;23:1192–9. This North American randomized trial demonstrated improved biochemical control with combined brachytherapy and EBRT compared to EBRT alone. However, because this study was relatively small, the external-beam dose in the control arm was suboptimal and high-dose rate brachytherapy boost was used rather than the more widely used approach of radioactive seed implant, this study is not widely cited in the brachytherapy literature.

    Article  PubMed  Google Scholar 

  39. Hoskin PJ, Motohashi K, Bownes P, Bryant L, Ostler P. High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial. Radiother Oncol. 2007;84:114–20.

    Article  PubMed  Google Scholar 

  40. Stock RG, Stone NN, Tabert A, Iannuzzi C, DeWyngaert JK. A dose-response study for i-125 prostate implants. Int J Radiat Oncol Biol Phys. 1998;41:101–8.

    Article  PubMed  CAS  Google Scholar 

  41. Kao J, Stone NN, Lavaf A, et al. (125)i monotherapy using d90 implant doses of 180 gy or greater. Int J Radiat Oncol Biol Phys. 2008;70:96–101.

    Article  PubMed  CAS  Google Scholar 

  42. Ho AY, Burri RJ, Cesaretti JA, Stone NN, Stock RG. Radiation dose predicts for biochemical control in intermediate-risk prostate cancer patients treated with low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2009;75:16–22.

    Article  PubMed  CAS  Google Scholar 

  43. Stock RG, Stone NN, Cesaretti JA, Rosenstein BS. Biologically effective dose values for prostate brachytherapy: effects on psa failure and posttreatment biopsy results. Int J Radiat Oncol Biol Phys. 2006;64:527–33.

    Article  PubMed  Google Scholar 

  44. Stock RG, Yalamanchi S, Hall SJ, Stone NN. Impact of hormonal therapy on intermediate risk prostate cancer treated with combination brachytherapy and external beam irradiation. J Urol. 2010;183:546–50.

    Article  PubMed  CAS  Google Scholar 

  45. Bittner N, Merrick GS, Wallner KE, et al. Whole-pelvis radiotherapy in combination with interstitial brachytherapy: does coverage of the pelvic lymph nodes improve treatment outcome in high-risk prostate cancer? Int J Radiat Oncol Biol Phys. 2010;76:1078–84.

    Article  PubMed  Google Scholar 

  46. Widmark A, Klepp O, Solberg A, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (spcg-7/sfuo-3): an open randomised phaseIII trial. Lancet. 2009;373:301–8.

    Article  PubMed  CAS  Google Scholar 

  47. Carpenter TJ, Forsythe K, Kao J, Stone NN, Stock RG. Outcomes for patients with extraprostatic prostate cancer treated with trimodality therapy, including brachytherapy, external beam radiotherapy, and hormone therapy. Brachytherapy 2010 [Epub ahead of print].

  48. D’Amico AV, Moran BJ, Braccioforte MH, et al. Risk of death from prostate cancer after brachytherapy alone or with radiation, androgen suppression therapy, or both in men with high-risk disease. J Clin Oncol. 2009;27:3923–8.

    Article  PubMed  Google Scholar 

  49. Burri RJ, Stone NN, Unger P, Stock RG. Long-term outcome and toxicity of salvage brachytherapy for local failure after initial radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;77:1338–44.

    Article  PubMed  Google Scholar 

  50. Nguyen PL, D’Amico AV, Lee AK, Suh WW. Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure: a systematic review of the literature. Cancer. 2007;110:1417–28.

    Article  PubMed  Google Scholar 

Download references

Disclosures

Dr. J. A. Cesaretti: none. Johnny Kao has received grants or has grants pending from Pfizer and OSI Pharmaceuticals, and has received payment for the development of educational services from Sanofi-Aventis. Dr. Nelson Stone has served as a board member for Prologics LLC and the Prostate Cancer Education Council; has served as a consultant for Nihon Medi-Physics; and has received honoraria from Centocor, Diversified Conference Management, Ferring Pharmaceuticals, and Bayer. Dr. Richard Stock has received honoraria from Bard Pharmaceuticals and has received payment for the development of educational services from Diversified Conference Management.

Author information

Authors and Affiliations

  1. Florida Cancer Physicians Network, Florida Radiation Oncology Group, 717 West Robertson Street, Brandon, FL, 33511, USA

    Johnny Kao

  2. Florida Radiation Oncology Group, 3599 University Boulevard South, #1000, Jacksonville, FL, 32216, USA

    Jamie A. Cesaretti

  3. Mount Sinai School of Medicine, 1 Timber Trail, Suffern, New York, NY, 10901, USA

    Nelson N. Stone

  4. Mount Sinai School of Medicine, 1 Gustave Levy Place, Box 1236, New York, NY, 10029, USA

    Richard G. Stock

Authors
  1. Johnny Kao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jamie A. Cesaretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nelson N. Stone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard G. Stock
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johnny Kao.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kao, J., Cesaretti, J.A., Stone, N.N. et al. Update on Prostate Brachytherapy: Long-term Outcomes and Treatment-related Morbidity. Curr Urol Rep 12, 237–242 (2011). https://doi.org/10.1007/s11934-011-0183-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-011-0183-3

Keywords

Search

Navigation