Recommendations for radiation therapy in prostate cancer

The authors aimed to determine the benefit of brachytherapy in men with prostate cancer.

The authors recommended brachytherapy treatments in men with low-, intermediate- and high-risk prostate cancer alone or in combination with other treatments.

Brachytherapy is a form of radiation therapy. It involves implanting a seed or source of radiation inside or next to the tumor area. A high radiation dose is then applied to the tumor, reducing damage to surrounding healthy cells, and killing tumor cells. Low-dose rate (LDR) brachytherapy delivers a high dose of radiation at a low-dose rate from implants placed permanently at the tumor site. High-dose rate (HDR) brachytherapy delivers radiation placed close to or inside the tumor at a high-rate from temporarily placed implants.

Other forms of radiation include external beam radiotherapy (EBRT). EBRT is commonly used in men with localised (confined to the prostate gland) or locally advanced prostate cancer (spread outside the prostate gland). It directs an external beam of radiation at the tumor site to target and kill tumor cells. Prostate surgery and hormone therapy are also treatment options used in prostate cancer. Surgery involves the surgical removal of the prostate gland. Hormone therapy targets the male sex hormones active in prostate cancer, such as testosterone.

The American Society of Clinical Oncology/Cancer Care Ontario gathered a panel of experts to determine guidelines for the use of brachytherapy in men with low, intermediate and high-risk prostate cancer.

For patients with low-risk cancer (confined to the prostate gland), LDR alone, EBRT alone, or prostate surgery should be considered.

Patients with intermediate-risk prostate cancer (confined to the prostate gland, higher prostate specific antigen levels [PSA – protein elevated in the blood in the presence of prostate cancer]) should consider EBRT with or without hormone therapy. They should also consider LDR or HDR brachytherapy.

Patients with low-risk intermediate cancer (PSA levels 10-20 ng/mL and Gleason score 6 or 7 [a measure of the aggressiveness of the cancer]) should consider LDR brachytherapy alone. Patients with high-risk prostate cancer (spread from the gland into surrounding organs) receiving EBRT and hormone therapy should consider LDR or HDR brachytherapy also.

The authors recommended brachytherapy treatments in men with low-, intermediate- and high-risk prostate cancer alone or in combination with other treatments.