The evolving role of prostate brachytherapy.
BACKGROUND: The publication of several large studies with long-term results on the use of prostate brachytherapy has resulted in increased use of this option for patients with localized prostate cancer. METHODS: A historical review of brachytherapy as an approach to prostate cancer management is provided, as well as a general summary of the implant technique and the results to date according to patient risk. The effects of combination therapies for specific patient groups are also reviewed. RESULTS: A recent 12-year follow-up reported no failures after 10 years, and 75% of recurrences occurred with-in the first 5 years. Patients at low risk for failure based on stage, grade, and prostate-specific antigen (PSA) parameters are likely to have disease confined to the prostate. Those with more advanced disease are likely to have a lower probability of cure with brachytherapy as monotherapy. Complications involve primarily the urinary tract. Ideal candidates have a PSA of =10, Gleason score of =7, and low-volume/low-stage disease (stage T1c or T2a). Patients with more-advanced disease are candidates for brachytherapy combined with external-beam radiation therapy (EBRT). For high-risk men with multiple adverse prognostic features, consideration should be given to clinical trials investigating innovative treatment combinations (eg, the addition of androgen blockade, and EBRT). CONCLUSIONS: The rarity of failures after 5 years and the absence of recurrence after 10 years suggest a that brachytherapy for localized prostate cancer can provide durable disease control. Future improvements in pathologic tools may lead to selection of patients more likely to respond well to brachytherapy.