Andrew Loblaw, MD, FRCPC, MSc
The American Society of Clinical Oncology (ASCO) and Cancer Care Ontario have jointly updated their guideline for using brachytherapy treatment for patients with newly diagnosed prostate cancer who require or choose active treatment and are not considering, or are not suitable for, active surveillance.1
The update provides evidence-based recommendations for different patient risk groups, and it clarifies the most effective forms of brachytherapy for each patient population.
The new recommendation for patients with low-risk prostate cancer who require or choose active treatment is that oncologists and other healthcare practitioners should offer either LDR brachytherapy alone, EBRT alone, or radical prostatectomy alone. The guideline qualifies that patients should be counseled in a balanced, objective manner on all their treatment and management options, preferably from multiple disciplines, including surgery, EBRT, and active surveillance.
For patients with intermediate-risk prostate cancer choosing EBRT with or without androgen-deprivation therapy (ADT), the guideline now recommends that LDR or high-dose rate (HDR) brachytherapy boost should be offered to eligible patients. For low-intermediate risk prostate cancer, defined as Gleason score 7, prostate-specific antigen (PSA) <10 ng/mL or Gleason score 6, PSA 10 to 20 ng/mL, LDR brachytherapy may be offered as monotherapy. Similarly, eligible patients with high-risk prostate cancer who are receiving EBRT and ADT should be offered LDR or HDR brachytherapy boost.
It was also determined that iodine-125 and palladium-103 are reasonable isotope options for patients who are receiving LDR brachytherapy. The guideline notes, however, that no recommendation can be given against or in favor of using cesium-131 or HDR monotherapy.
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