This guideline presents evidence-based consensus recommendations for high-dose-rate (HDR) brachytherapy boost in combination with external beam radiotherapy (EBRT) for the primary treatment of localized prostate cancer.
The American Brachytherapy Society convened a task force for addressing key questions concerning prostate HDR brachytherapy boost with EBRT for the primary treatment of localized prostate cancer. A comprehensive literature search was conducted to identify prospective and large retrospective studies involving HDR brachytherapy combined with EBRT. Outcomes of interest included biochemical and/or disease control, toxicity, patient-reported quality of life, and the role of androgen deprivation therapy.
HDR brachytherapy using Ir-192 in combination with EBRT is an appropriate treatment option for men with intermediate- and high-risk prostate cancer. CT, ultrasound, and/or MRI are imaging platforms that may be utilized for treatment planning and delivery. A single implant/fraction of 15 Gy or 2 implants/fractions of 9.5-11 Gy each are acceptable regimens in combination with EBRT at a dose equivalent of 45-50.4 Gy in 1.8-2.0 Gy fractions. The addition of HDR brachytherapy is expected to improve biochemical control compared with dose escalated EBRT alone. HDR brachytherapy boost is expected to achieve similar biochemical control outcomes as a low dose rate (LDR) brachytherapy boost. Androgen deprivation therapy is recommended for men with unfavorable intermediate and high-risk disease, with varying duration dependent on cancer risk. Use of an HDR brachytherapy technique, as opposed to LDR permanent seeds, has been shown to have less acute genitourinary (GU) and gastrointestinal (GI) toxicity following treatment.
For men with intermediate- and high-risk prostate cancer, HDR brachytherapy boost is a safe and effective technique for dose-escalation that can achieve superior biochemical control compared with EBRT alone, possibly with an improved GU and GI side effect profile compared with an LDR brachytherapy technique.
Brachytherapy. 2025 Jul 23 [Epub ahead of print]
Sagar A Patel, Marisa Kollmeier, Juanita Crook, Daniel Krauss, Gerard Morton, Albert J Chang, Joelle Helou, I-Chow Hsu, Cynthia Menard, Shyamal Patel, Tyler Robin, Peter J Rossi, Michael J Zelefsky, Mitchell R Kamrava
Department of Radiation Oncology & Urology, Emory University, Atlanta, GA. Electronic address: ., Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Surgery, Radiation Oncology, and Developmental Radiotherapeutics, University of British Columbia, Kelowna, British Columbia, Canada., Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI., Department of Radiation Oncology, University of Toronto, Odette Cancer Center, Toronto, Ontario, Canada., Department of Radiation Oncology, University of California, Los Angeles CA., London Regional Cancer Program, Division of Radiation Oncology, Western University, London, Ontario, Canada., Department of Radiation Oncology, University of California, San Francisco CA., Department of Radiation Oncology Centre Hospitalier de I'Universite de Montreal (CHUM), Montreal, Quebec, Canada., Dignity Health Care Institute, Phoenix, AZ., Department of Radiation Oncology, University of Colorado, Aurora, CO., Calaway Young Cancer Center, Valley View Hospital, Glenwood Springs CO., Department of Radiation Oncology, New York University Langone Medical Center, New York NY., Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles CA.