Low dose rate brachytherapy for primary treatment of localized prostate cancer: A systemic review and executive summary of an evidence-based consensus statement.

The purpose of this guideline is to present evidence-based consensus recommendations for low dose rate (LDR) permanent seed brachytherapy for the primary treatment of prostate cancer.

The American Brachytherapy Society convened a task force for addressing key questions concerning ultrasound-based LDR prostate brachytherapy for the primary treatment of prostate cancer. A comprehensive literature search was conducted to identify prospective and multi-institutional retrospective studies involving LDR brachytherapy as monotherapy or boost in combination with external beam radiation therapy with or without adjuvant androgen deprivation therapy. Outcomes included disease control, toxicity, and quality of life.

LDR prostate brachytherapy monotherapy is an appropriate treatment option for low risk and favorable intermediate risk disease. LDR brachytherapy boost in combination with external beam radiation therapy is appropriate for unfavorable intermediate risk and high-risk disease. Androgen deprivation therapy is recommended in unfavorable intermediate risk and high-risk disease. Acceptable radionuclides for LDR brachytherapy include iodine-125, palladium-103, and cesium-131. Although brachytherapy monotherapy is associated with increased urinary obstructive and irritative symptoms that peak within the first 3 months after treatment, the median time toward symptom resolution is approximately 1 year for iodine-125 and 6 months for palladium-103. Such symptoms can be mitigated with short-term use of alpha blockers. Combination therapy is associated with worse urinary, bowel, and sexual symptoms than monotherapy. A prostate specific antigen <= 0.2 ng/mL at 4 years after LDR brachytherapy may be considered a biochemical definition of cure.

LDR brachytherapy is a convenient, effective, and well-tolerated treatment for prostate cancer.

Brachytherapy. 2021 Sep 08 [Epub ahead of print]

Martin T King, Mira Keyes, Steven J Frank, Juanita M Crook, Wayne M Butler, Peter J Rossi, Brett W Cox, Timothy N Showalter, Firas Mourtada, Louis Potters, Richard G Stock, Marisa A Kollmeier, Michael J Zelefsky, Brian J Davis, Gregory S Merrick, Peter F Orio

Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA. Electronic address: ., Department of Radiation Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada., Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX., Department of Radiation Oncology, British Columbia Cancer Agency, University of British Columbia, Kelowna, Canada., Department of Radiation Oncology, Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV., Calaway Young Cancer Center, Valley View Hospital, Glenwood Springs, CO., Department of Radiation Oncology, Rush University Medical Center, Chicago, IL., Department of Radiation Oncology, University of Virginia, Charlottesville, VA., Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE., Department of Radiation Oncology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY., Department of Radiation Oncology, Mt. Sinai Medical Center, New York, NY., Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA.