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BrachytherapyThe precise answer for tackling prostate cancer
Prostate key messages
Prostate brachytherapy Core key messages in a nutshell
The precise answer for tackling prostate cancer
Maximal conformity ndash precise targeting of effective dose to tumor with sparing of healthy tissues and organs (working lsquofrom the inside outrsquo)
‒ Customized delivery of radiation dose tailored to the precise needs to treat the tumor
Demonstrated efficacy ndash equivalent to EBRT and prostatectomy (surgery)
Well tolerated ndash minimizes side effects compared to EBRT and prostatectomy
Patient centered ndash shorter treatment and recovery times minimizes disruption and impact on QOL
Optimizes healthcare resources
Solid heritage ndash extensive clinical experience backed by technological advances confirm brachytherapy as a standard of care in prostate cancer management
The introBrachytherapy is a cornerstone in prostate cancer management
The incidence of prostate cancer is rising and will continue to increase as the population ages Cancer of the prostate is the most commonly diagnosed malignancy in Western men
Effective treatment options mean many men can achieve good cancer control and quality of life Innovation in cancer treatment is key to addressing current and future needs in patient care
Tumor control and survival rates for prostate cancer achieved with brachytherapy EBRT and surgery are excellent and comparable across the different modalities
Other factors such as treatment duration side effects impact on quality of life and patient preference are therefore important considerations when making treatment choices
Innovations in brachytherapy continue to enhance treatment options allowing for care to become patient-centered tailored by individual preferences and needs
Prostate brachytherapy The key messages
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which equals that of RP and EBRT
LDR seed therapy allows a high dose of radiation to be delivered precisely while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus minimized toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimized impact on functional outcomes and quality of life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provide a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Prostate cancer has been treated with LDR seed brachytherapy since the 1960s It has become a standard of care in many countries through its disease specific survival and unrivalled patient benefits Recent technological advances have augmented the quality of treatment which can be achieved with LDR and HDR techniques
ConformityConformity
EfficacyEfficacy
Well toleratedWell tolerated
Patient centeredPatient centered
Optimizes Optimizes resourcesresources
HeritageHeritage
Prostate brachytherapy Maximal conformity ndash precise targeting Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern radiotherapy techniques such as IMRT and tomotherapy
Tailored treatment
The number and position of seeds (LDR) or the position and duration of the dwell time of the radioactive source
(HDR) used to deliver the radiation dose in prostate brachytherapy can be tailored specifically to the patientrsquos
individual needs ndash maximizing outcomes and at the same time limiting surrounding tissue or organ damage
Modern techniques
Modern prostate brachytherapy takes advantage of advances in ultrasound imaging hardware technology and
software development to provide implants under real-time ultrasound guidance coupled with a dynamic assessment of
the implant which thus optimizes the precision of dose delivery to the target area HDR brachytherapy demonstrates
superior conformity to techniques such as IMRT and tomotherapy with sparing of healthy tissues and reduced
radiation exposure
Minimally invasive
Compared to radical prostatectomy the minimally invasive nature of prostate brachytherapy significantly reduces the
risk of side effects such as sexual dysfunction and long term urinary problems as well as allowing shorter recovery
times
Quality control
Prostate brachytherapy is the ultimate in terms of quality control of treatment delivery ndash dosimetry and insertion can
be done under real-time conditions ensuring that the desired dose is delivered exactly where it is needed maximizing
treatment outcomes (closed loop treatment)
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which match those of RP and EBRT
Prostate brachytherapy Demonstrated efficacy
Equivalent cancer control rates and outcomes
LDR seed therapy demonstrates excellent 5- 10- and even 15-year treatment outcomes matching those reported in
studies of radical prostatectomy (RP) and external beam radiation therapy (EBRT) Data on HDR in combination with
EBRT demonstrate excellent 5- and 10-year outcomes and increasing data on HDR monotherapy demonstrate similar
excellent prostate cancer treatment outcomes
Superior efficacy
In a matched-pair analysis of low- to intermediate-risk patients with localized prostate cancer permanent seed
implants were shown to produce significantly better prostate cancer control rates at 5 years than traditional EBRT
Flexible synergistic treatment
Both permanent (LDR seed therapy) and temporary (HDR) implants have shown to work synergistically (as a lsquoboostrsquo)
with EBRT and with androgen deprivation therapy (ADT) in higher risk patients
LDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy Well tolerated with minimized side effects
Minimizes dose to surrounding tissuespares surrounding organs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) ensures radiation is precisely targeted to the area
of the tumor eliminating unnecessary exposure and damage to surrounding healthy tissues and organs
Use of HDR as a lsquoboostrsquo after EBRT allows dose escalation to target areas whilst minimizing exposure to healthy
tissues and organs
Minimizes toxicity and side effects
Patients receiving prostate brachytherapy (LDR seed therapy and HDR brachytherapy) suffer significantly decreased
side effects such as bowel function and bother and sexual dysfunction In addition prostate brachytherapy
demonstrates better urinary incontinence rates compared to RP and EBRT
Urinary function
Urinary function is affected by all radiotherapy and surgical procedures in localized prostate cancer Prostate
brachytherapy (LDR seed therapy and HDR brachytherapy) may result in transient urinary function issues that
generally resolve rapidly ndash consistent with the working of the radiation with lower longer-term urinary issues compared
to RP
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
Prostate brachytherapy Patient-centered with minimized impact on QoL
Minimally invasive shorter recovery time
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) avoids the physical and emotional trauma
potential blood loss and longer hospitalization associated with a major surgical procedure such as RP
Recovery from prostate brachytherapy (LDR seed therapy and HDR brachytherapy) is significantly quicker
(2ndash3 days) compared to RP (4ndash6 weeks) which means patientsrsquo lives are not put on hold
Shorter treatment duration ndash reduced disruption to daily life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) placement is direct to the tumor site so the
treatment can be completed in a day or days on an outpatient basis compared to a period of weeks with EBRT
Lower personal and hospital costs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy ) is a short outpatient procedure completed in 1-2
days This makes it less intrusive on daily life and lowers personal (and hospital) costs associated with the multiple
treatments sessions of EBRT and lengthy RP recovery time
Minimal disruption to patientsrsquo quality of life
Studies using specific QoL scales demonstrate that brachytherapy is generally associated with minimal impact on
HRQoL with respect to urinary sexual and bowel function and with a favorable HRQoL profile compared to EBRT and
RP and even newer techniques such as Da Vinci and cryotherapy
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Cost effectiveness vs frequently used alternative modalities
Prostate brachytherapy Optimized healthcare resources
Like IMRT and proton therapy brachytherapy delivers high dose to tumor targets while limiting damage to healthy
tissues but brachytherapy only needs low investment and maintenance costs making brachytherapy more attractive
for cost-effectiveness considerations and for healthcare resource investment decisions
Modern radiotherapy with low investment costs
Brachytherapy has been shown to be a cost-effective alternative to surgery EBRT and newer technologies such as
IMRT or proton therapy
A recent review by the ICER group in the USA confirmed brachytherapy as a lsquohigh valuersquo treatment modality compared
to approaches such as IMRT and protons
Use of brachytherapy for appropriate patients allows a department to free up time for Linac use reducing congestion
maximizing patient flow and optimizing department resources
Brachytherapy offers opportunity to maximize radiotherapy department resources
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Core key messages in a nutshell
The precise answer for tackling prostate cancer
Maximal conformity ndash precise targeting of effective dose to tumor with sparing of healthy tissues and organs (working lsquofrom the inside outrsquo)
‒ Customized delivery of radiation dose tailored to the precise needs to treat the tumor
Demonstrated efficacy ndash equivalent to EBRT and prostatectomy (surgery)
Well tolerated ndash minimizes side effects compared to EBRT and prostatectomy
Patient centered ndash shorter treatment and recovery times minimizes disruption and impact on QOL
Optimizes healthcare resources
Solid heritage ndash extensive clinical experience backed by technological advances confirm brachytherapy as a standard of care in prostate cancer management
The introBrachytherapy is a cornerstone in prostate cancer management
The incidence of prostate cancer is rising and will continue to increase as the population ages Cancer of the prostate is the most commonly diagnosed malignancy in Western men
Effective treatment options mean many men can achieve good cancer control and quality of life Innovation in cancer treatment is key to addressing current and future needs in patient care
Tumor control and survival rates for prostate cancer achieved with brachytherapy EBRT and surgery are excellent and comparable across the different modalities
Other factors such as treatment duration side effects impact on quality of life and patient preference are therefore important considerations when making treatment choices
Innovations in brachytherapy continue to enhance treatment options allowing for care to become patient-centered tailored by individual preferences and needs
Prostate brachytherapy The key messages
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which equals that of RP and EBRT
LDR seed therapy allows a high dose of radiation to be delivered precisely while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus minimized toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimized impact on functional outcomes and quality of life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provide a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Prostate cancer has been treated with LDR seed brachytherapy since the 1960s It has become a standard of care in many countries through its disease specific survival and unrivalled patient benefits Recent technological advances have augmented the quality of treatment which can be achieved with LDR and HDR techniques
ConformityConformity
EfficacyEfficacy
Well toleratedWell tolerated
Patient centeredPatient centered
Optimizes Optimizes resourcesresources
HeritageHeritage
Prostate brachytherapy Maximal conformity ndash precise targeting Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern radiotherapy techniques such as IMRT and tomotherapy
Tailored treatment
The number and position of seeds (LDR) or the position and duration of the dwell time of the radioactive source
(HDR) used to deliver the radiation dose in prostate brachytherapy can be tailored specifically to the patientrsquos
individual needs ndash maximizing outcomes and at the same time limiting surrounding tissue or organ damage
Modern techniques
Modern prostate brachytherapy takes advantage of advances in ultrasound imaging hardware technology and
software development to provide implants under real-time ultrasound guidance coupled with a dynamic assessment of
the implant which thus optimizes the precision of dose delivery to the target area HDR brachytherapy demonstrates
superior conformity to techniques such as IMRT and tomotherapy with sparing of healthy tissues and reduced
radiation exposure
Minimally invasive
Compared to radical prostatectomy the minimally invasive nature of prostate brachytherapy significantly reduces the
risk of side effects such as sexual dysfunction and long term urinary problems as well as allowing shorter recovery
times
Quality control
Prostate brachytherapy is the ultimate in terms of quality control of treatment delivery ndash dosimetry and insertion can
be done under real-time conditions ensuring that the desired dose is delivered exactly where it is needed maximizing
treatment outcomes (closed loop treatment)
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which match those of RP and EBRT
Prostate brachytherapy Demonstrated efficacy
Equivalent cancer control rates and outcomes
LDR seed therapy demonstrates excellent 5- 10- and even 15-year treatment outcomes matching those reported in
studies of radical prostatectomy (RP) and external beam radiation therapy (EBRT) Data on HDR in combination with
EBRT demonstrate excellent 5- and 10-year outcomes and increasing data on HDR monotherapy demonstrate similar
excellent prostate cancer treatment outcomes
Superior efficacy
In a matched-pair analysis of low- to intermediate-risk patients with localized prostate cancer permanent seed
implants were shown to produce significantly better prostate cancer control rates at 5 years than traditional EBRT
Flexible synergistic treatment
Both permanent (LDR seed therapy) and temporary (HDR) implants have shown to work synergistically (as a lsquoboostrsquo)
with EBRT and with androgen deprivation therapy (ADT) in higher risk patients
LDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy Well tolerated with minimized side effects
Minimizes dose to surrounding tissuespares surrounding organs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) ensures radiation is precisely targeted to the area
of the tumor eliminating unnecessary exposure and damage to surrounding healthy tissues and organs
Use of HDR as a lsquoboostrsquo after EBRT allows dose escalation to target areas whilst minimizing exposure to healthy
tissues and organs
Minimizes toxicity and side effects
Patients receiving prostate brachytherapy (LDR seed therapy and HDR brachytherapy) suffer significantly decreased
side effects such as bowel function and bother and sexual dysfunction In addition prostate brachytherapy
demonstrates better urinary incontinence rates compared to RP and EBRT
Urinary function
Urinary function is affected by all radiotherapy and surgical procedures in localized prostate cancer Prostate
brachytherapy (LDR seed therapy and HDR brachytherapy) may result in transient urinary function issues that
generally resolve rapidly ndash consistent with the working of the radiation with lower longer-term urinary issues compared
to RP
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
Prostate brachytherapy Patient-centered with minimized impact on QoL
Minimally invasive shorter recovery time
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) avoids the physical and emotional trauma
potential blood loss and longer hospitalization associated with a major surgical procedure such as RP
Recovery from prostate brachytherapy (LDR seed therapy and HDR brachytherapy) is significantly quicker
(2ndash3 days) compared to RP (4ndash6 weeks) which means patientsrsquo lives are not put on hold
Shorter treatment duration ndash reduced disruption to daily life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) placement is direct to the tumor site so the
treatment can be completed in a day or days on an outpatient basis compared to a period of weeks with EBRT
Lower personal and hospital costs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy ) is a short outpatient procedure completed in 1-2
days This makes it less intrusive on daily life and lowers personal (and hospital) costs associated with the multiple
treatments sessions of EBRT and lengthy RP recovery time
Minimal disruption to patientsrsquo quality of life
Studies using specific QoL scales demonstrate that brachytherapy is generally associated with minimal impact on
HRQoL with respect to urinary sexual and bowel function and with a favorable HRQoL profile compared to EBRT and
RP and even newer techniques such as Da Vinci and cryotherapy
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Cost effectiveness vs frequently used alternative modalities
Prostate brachytherapy Optimized healthcare resources
Like IMRT and proton therapy brachytherapy delivers high dose to tumor targets while limiting damage to healthy
tissues but brachytherapy only needs low investment and maintenance costs making brachytherapy more attractive
for cost-effectiveness considerations and for healthcare resource investment decisions
Modern radiotherapy with low investment costs
Brachytherapy has been shown to be a cost-effective alternative to surgery EBRT and newer technologies such as
IMRT or proton therapy
A recent review by the ICER group in the USA confirmed brachytherapy as a lsquohigh valuersquo treatment modality compared
to approaches such as IMRT and protons
Use of brachytherapy for appropriate patients allows a department to free up time for Linac use reducing congestion
maximizing patient flow and optimizing department resources
Brachytherapy offers opportunity to maximize radiotherapy department resources
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
The introBrachytherapy is a cornerstone in prostate cancer management
The incidence of prostate cancer is rising and will continue to increase as the population ages Cancer of the prostate is the most commonly diagnosed malignancy in Western men
Effective treatment options mean many men can achieve good cancer control and quality of life Innovation in cancer treatment is key to addressing current and future needs in patient care
Tumor control and survival rates for prostate cancer achieved with brachytherapy EBRT and surgery are excellent and comparable across the different modalities
Other factors such as treatment duration side effects impact on quality of life and patient preference are therefore important considerations when making treatment choices
Innovations in brachytherapy continue to enhance treatment options allowing for care to become patient-centered tailored by individual preferences and needs
Prostate brachytherapy The key messages
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which equals that of RP and EBRT
LDR seed therapy allows a high dose of radiation to be delivered precisely while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus minimized toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimized impact on functional outcomes and quality of life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provide a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Prostate cancer has been treated with LDR seed brachytherapy since the 1960s It has become a standard of care in many countries through its disease specific survival and unrivalled patient benefits Recent technological advances have augmented the quality of treatment which can be achieved with LDR and HDR techniques
ConformityConformity
EfficacyEfficacy
Well toleratedWell tolerated
Patient centeredPatient centered
Optimizes Optimizes resourcesresources
HeritageHeritage
Prostate brachytherapy Maximal conformity ndash precise targeting Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern radiotherapy techniques such as IMRT and tomotherapy
Tailored treatment
The number and position of seeds (LDR) or the position and duration of the dwell time of the radioactive source
(HDR) used to deliver the radiation dose in prostate brachytherapy can be tailored specifically to the patientrsquos
individual needs ndash maximizing outcomes and at the same time limiting surrounding tissue or organ damage
Modern techniques
Modern prostate brachytherapy takes advantage of advances in ultrasound imaging hardware technology and
software development to provide implants under real-time ultrasound guidance coupled with a dynamic assessment of
the implant which thus optimizes the precision of dose delivery to the target area HDR brachytherapy demonstrates
superior conformity to techniques such as IMRT and tomotherapy with sparing of healthy tissues and reduced
radiation exposure
Minimally invasive
Compared to radical prostatectomy the minimally invasive nature of prostate brachytherapy significantly reduces the
risk of side effects such as sexual dysfunction and long term urinary problems as well as allowing shorter recovery
times
Quality control
Prostate brachytherapy is the ultimate in terms of quality control of treatment delivery ndash dosimetry and insertion can
be done under real-time conditions ensuring that the desired dose is delivered exactly where it is needed maximizing
treatment outcomes (closed loop treatment)
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which match those of RP and EBRT
Prostate brachytherapy Demonstrated efficacy
Equivalent cancer control rates and outcomes
LDR seed therapy demonstrates excellent 5- 10- and even 15-year treatment outcomes matching those reported in
studies of radical prostatectomy (RP) and external beam radiation therapy (EBRT) Data on HDR in combination with
EBRT demonstrate excellent 5- and 10-year outcomes and increasing data on HDR monotherapy demonstrate similar
excellent prostate cancer treatment outcomes
Superior efficacy
In a matched-pair analysis of low- to intermediate-risk patients with localized prostate cancer permanent seed
implants were shown to produce significantly better prostate cancer control rates at 5 years than traditional EBRT
Flexible synergistic treatment
Both permanent (LDR seed therapy) and temporary (HDR) implants have shown to work synergistically (as a lsquoboostrsquo)
with EBRT and with androgen deprivation therapy (ADT) in higher risk patients
LDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy Well tolerated with minimized side effects
Minimizes dose to surrounding tissuespares surrounding organs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) ensures radiation is precisely targeted to the area
of the tumor eliminating unnecessary exposure and damage to surrounding healthy tissues and organs
Use of HDR as a lsquoboostrsquo after EBRT allows dose escalation to target areas whilst minimizing exposure to healthy
tissues and organs
Minimizes toxicity and side effects
Patients receiving prostate brachytherapy (LDR seed therapy and HDR brachytherapy) suffer significantly decreased
side effects such as bowel function and bother and sexual dysfunction In addition prostate brachytherapy
demonstrates better urinary incontinence rates compared to RP and EBRT
Urinary function
Urinary function is affected by all radiotherapy and surgical procedures in localized prostate cancer Prostate
brachytherapy (LDR seed therapy and HDR brachytherapy) may result in transient urinary function issues that
generally resolve rapidly ndash consistent with the working of the radiation with lower longer-term urinary issues compared
to RP
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
Prostate brachytherapy Patient-centered with minimized impact on QoL
Minimally invasive shorter recovery time
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) avoids the physical and emotional trauma
potential blood loss and longer hospitalization associated with a major surgical procedure such as RP
Recovery from prostate brachytherapy (LDR seed therapy and HDR brachytherapy) is significantly quicker
(2ndash3 days) compared to RP (4ndash6 weeks) which means patientsrsquo lives are not put on hold
Shorter treatment duration ndash reduced disruption to daily life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) placement is direct to the tumor site so the
treatment can be completed in a day or days on an outpatient basis compared to a period of weeks with EBRT
Lower personal and hospital costs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy ) is a short outpatient procedure completed in 1-2
days This makes it less intrusive on daily life and lowers personal (and hospital) costs associated with the multiple
treatments sessions of EBRT and lengthy RP recovery time
Minimal disruption to patientsrsquo quality of life
Studies using specific QoL scales demonstrate that brachytherapy is generally associated with minimal impact on
HRQoL with respect to urinary sexual and bowel function and with a favorable HRQoL profile compared to EBRT and
RP and even newer techniques such as Da Vinci and cryotherapy
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Cost effectiveness vs frequently used alternative modalities
Prostate brachytherapy Optimized healthcare resources
Like IMRT and proton therapy brachytherapy delivers high dose to tumor targets while limiting damage to healthy
tissues but brachytherapy only needs low investment and maintenance costs making brachytherapy more attractive
for cost-effectiveness considerations and for healthcare resource investment decisions
Modern radiotherapy with low investment costs
Brachytherapy has been shown to be a cost-effective alternative to surgery EBRT and newer technologies such as
IMRT or proton therapy
A recent review by the ICER group in the USA confirmed brachytherapy as a lsquohigh valuersquo treatment modality compared
to approaches such as IMRT and protons
Use of brachytherapy for appropriate patients allows a department to free up time for Linac use reducing congestion
maximizing patient flow and optimizing department resources
Brachytherapy offers opportunity to maximize radiotherapy department resources
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy The key messages
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which equals that of RP and EBRT
LDR seed therapy allows a high dose of radiation to be delivered precisely while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus minimized toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimized impact on functional outcomes and quality of life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provide a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Prostate cancer has been treated with LDR seed brachytherapy since the 1960s It has become a standard of care in many countries through its disease specific survival and unrivalled patient benefits Recent technological advances have augmented the quality of treatment which can be achieved with LDR and HDR techniques
ConformityConformity
EfficacyEfficacy
Well toleratedWell tolerated
Patient centeredPatient centered
Optimizes Optimizes resourcesresources
HeritageHeritage
Prostate brachytherapy Maximal conformity ndash precise targeting Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern radiotherapy techniques such as IMRT and tomotherapy
Tailored treatment
The number and position of seeds (LDR) or the position and duration of the dwell time of the radioactive source
(HDR) used to deliver the radiation dose in prostate brachytherapy can be tailored specifically to the patientrsquos
individual needs ndash maximizing outcomes and at the same time limiting surrounding tissue or organ damage
Modern techniques
Modern prostate brachytherapy takes advantage of advances in ultrasound imaging hardware technology and
software development to provide implants under real-time ultrasound guidance coupled with a dynamic assessment of
the implant which thus optimizes the precision of dose delivery to the target area HDR brachytherapy demonstrates
superior conformity to techniques such as IMRT and tomotherapy with sparing of healthy tissues and reduced
radiation exposure
Minimally invasive
Compared to radical prostatectomy the minimally invasive nature of prostate brachytherapy significantly reduces the
risk of side effects such as sexual dysfunction and long term urinary problems as well as allowing shorter recovery
times
Quality control
Prostate brachytherapy is the ultimate in terms of quality control of treatment delivery ndash dosimetry and insertion can
be done under real-time conditions ensuring that the desired dose is delivered exactly where it is needed maximizing
treatment outcomes (closed loop treatment)
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which match those of RP and EBRT
Prostate brachytherapy Demonstrated efficacy
Equivalent cancer control rates and outcomes
LDR seed therapy demonstrates excellent 5- 10- and even 15-year treatment outcomes matching those reported in
studies of radical prostatectomy (RP) and external beam radiation therapy (EBRT) Data on HDR in combination with
EBRT demonstrate excellent 5- and 10-year outcomes and increasing data on HDR monotherapy demonstrate similar
excellent prostate cancer treatment outcomes
Superior efficacy
In a matched-pair analysis of low- to intermediate-risk patients with localized prostate cancer permanent seed
implants were shown to produce significantly better prostate cancer control rates at 5 years than traditional EBRT
Flexible synergistic treatment
Both permanent (LDR seed therapy) and temporary (HDR) implants have shown to work synergistically (as a lsquoboostrsquo)
with EBRT and with androgen deprivation therapy (ADT) in higher risk patients
LDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy Well tolerated with minimized side effects
Minimizes dose to surrounding tissuespares surrounding organs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) ensures radiation is precisely targeted to the area
of the tumor eliminating unnecessary exposure and damage to surrounding healthy tissues and organs
Use of HDR as a lsquoboostrsquo after EBRT allows dose escalation to target areas whilst minimizing exposure to healthy
tissues and organs
Minimizes toxicity and side effects
Patients receiving prostate brachytherapy (LDR seed therapy and HDR brachytherapy) suffer significantly decreased
side effects such as bowel function and bother and sexual dysfunction In addition prostate brachytherapy
demonstrates better urinary incontinence rates compared to RP and EBRT
Urinary function
Urinary function is affected by all radiotherapy and surgical procedures in localized prostate cancer Prostate
brachytherapy (LDR seed therapy and HDR brachytherapy) may result in transient urinary function issues that
generally resolve rapidly ndash consistent with the working of the radiation with lower longer-term urinary issues compared
to RP
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
Prostate brachytherapy Patient-centered with minimized impact on QoL
Minimally invasive shorter recovery time
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) avoids the physical and emotional trauma
potential blood loss and longer hospitalization associated with a major surgical procedure such as RP
Recovery from prostate brachytherapy (LDR seed therapy and HDR brachytherapy) is significantly quicker
(2ndash3 days) compared to RP (4ndash6 weeks) which means patientsrsquo lives are not put on hold
Shorter treatment duration ndash reduced disruption to daily life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) placement is direct to the tumor site so the
treatment can be completed in a day or days on an outpatient basis compared to a period of weeks with EBRT
Lower personal and hospital costs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy ) is a short outpatient procedure completed in 1-2
days This makes it less intrusive on daily life and lowers personal (and hospital) costs associated with the multiple
treatments sessions of EBRT and lengthy RP recovery time
Minimal disruption to patientsrsquo quality of life
Studies using specific QoL scales demonstrate that brachytherapy is generally associated with minimal impact on
HRQoL with respect to urinary sexual and bowel function and with a favorable HRQoL profile compared to EBRT and
RP and even newer techniques such as Da Vinci and cryotherapy
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Cost effectiveness vs frequently used alternative modalities
Prostate brachytherapy Optimized healthcare resources
Like IMRT and proton therapy brachytherapy delivers high dose to tumor targets while limiting damage to healthy
tissues but brachytherapy only needs low investment and maintenance costs making brachytherapy more attractive
for cost-effectiveness considerations and for healthcare resource investment decisions
Modern radiotherapy with low investment costs
Brachytherapy has been shown to be a cost-effective alternative to surgery EBRT and newer technologies such as
IMRT or proton therapy
A recent review by the ICER group in the USA confirmed brachytherapy as a lsquohigh valuersquo treatment modality compared
to approaches such as IMRT and protons
Use of brachytherapy for appropriate patients allows a department to free up time for Linac use reducing congestion
maximizing patient flow and optimizing department resources
Brachytherapy offers opportunity to maximize radiotherapy department resources
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Maximal conformity ndash precise targeting Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern radiotherapy techniques such as IMRT and tomotherapy
Tailored treatment
The number and position of seeds (LDR) or the position and duration of the dwell time of the radioactive source
(HDR) used to deliver the radiation dose in prostate brachytherapy can be tailored specifically to the patientrsquos
individual needs ndash maximizing outcomes and at the same time limiting surrounding tissue or organ damage
Modern techniques
Modern prostate brachytherapy takes advantage of advances in ultrasound imaging hardware technology and
software development to provide implants under real-time ultrasound guidance coupled with a dynamic assessment of
the implant which thus optimizes the precision of dose delivery to the target area HDR brachytherapy demonstrates
superior conformity to techniques such as IMRT and tomotherapy with sparing of healthy tissues and reduced
radiation exposure
Minimally invasive
Compared to radical prostatectomy the minimally invasive nature of prostate brachytherapy significantly reduces the
risk of side effects such as sexual dysfunction and long term urinary problems as well as allowing shorter recovery
times
Quality control
Prostate brachytherapy is the ultimate in terms of quality control of treatment delivery ndash dosimetry and insertion can
be done under real-time conditions ensuring that the desired dose is delivered exactly where it is needed maximizing
treatment outcomes (closed loop treatment)
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which match those of RP and EBRT
Prostate brachytherapy Demonstrated efficacy
Equivalent cancer control rates and outcomes
LDR seed therapy demonstrates excellent 5- 10- and even 15-year treatment outcomes matching those reported in
studies of radical prostatectomy (RP) and external beam radiation therapy (EBRT) Data on HDR in combination with
EBRT demonstrate excellent 5- and 10-year outcomes and increasing data on HDR monotherapy demonstrate similar
excellent prostate cancer treatment outcomes
Superior efficacy
In a matched-pair analysis of low- to intermediate-risk patients with localized prostate cancer permanent seed
implants were shown to produce significantly better prostate cancer control rates at 5 years than traditional EBRT
Flexible synergistic treatment
Both permanent (LDR seed therapy) and temporary (HDR) implants have shown to work synergistically (as a lsquoboostrsquo)
with EBRT and with androgen deprivation therapy (ADT) in higher risk patients
LDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy Well tolerated with minimized side effects
Minimizes dose to surrounding tissuespares surrounding organs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) ensures radiation is precisely targeted to the area
of the tumor eliminating unnecessary exposure and damage to surrounding healthy tissues and organs
Use of HDR as a lsquoboostrsquo after EBRT allows dose escalation to target areas whilst minimizing exposure to healthy
tissues and organs
Minimizes toxicity and side effects
Patients receiving prostate brachytherapy (LDR seed therapy and HDR brachytherapy) suffer significantly decreased
side effects such as bowel function and bother and sexual dysfunction In addition prostate brachytherapy
demonstrates better urinary incontinence rates compared to RP and EBRT
Urinary function
Urinary function is affected by all radiotherapy and surgical procedures in localized prostate cancer Prostate
brachytherapy (LDR seed therapy and HDR brachytherapy) may result in transient urinary function issues that
generally resolve rapidly ndash consistent with the working of the radiation with lower longer-term urinary issues compared
to RP
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
Prostate brachytherapy Patient-centered with minimized impact on QoL
Minimally invasive shorter recovery time
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) avoids the physical and emotional trauma
potential blood loss and longer hospitalization associated with a major surgical procedure such as RP
Recovery from prostate brachytherapy (LDR seed therapy and HDR brachytherapy) is significantly quicker
(2ndash3 days) compared to RP (4ndash6 weeks) which means patientsrsquo lives are not put on hold
Shorter treatment duration ndash reduced disruption to daily life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) placement is direct to the tumor site so the
treatment can be completed in a day or days on an outpatient basis compared to a period of weeks with EBRT
Lower personal and hospital costs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy ) is a short outpatient procedure completed in 1-2
days This makes it less intrusive on daily life and lowers personal (and hospital) costs associated with the multiple
treatments sessions of EBRT and lengthy RP recovery time
Minimal disruption to patientsrsquo quality of life
Studies using specific QoL scales demonstrate that brachytherapy is generally associated with minimal impact on
HRQoL with respect to urinary sexual and bowel function and with a favorable HRQoL profile compared to EBRT and
RP and even newer techniques such as Da Vinci and cryotherapy
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Cost effectiveness vs frequently used alternative modalities
Prostate brachytherapy Optimized healthcare resources
Like IMRT and proton therapy brachytherapy delivers high dose to tumor targets while limiting damage to healthy
tissues but brachytherapy only needs low investment and maintenance costs making brachytherapy more attractive
for cost-effectiveness considerations and for healthcare resource investment decisions
Modern radiotherapy with low investment costs
Brachytherapy has been shown to be a cost-effective alternative to surgery EBRT and newer technologies such as
IMRT or proton therapy
A recent review by the ICER group in the USA confirmed brachytherapy as a lsquohigh valuersquo treatment modality compared
to approaches such as IMRT and protons
Use of brachytherapy for appropriate patients allows a department to free up time for Linac use reducing congestion
maximizing patient flow and optimizing department resources
Brachytherapy offers opportunity to maximize radiotherapy department resources
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which match those of RP and EBRT
Prostate brachytherapy Demonstrated efficacy
Equivalent cancer control rates and outcomes
LDR seed therapy demonstrates excellent 5- 10- and even 15-year treatment outcomes matching those reported in
studies of radical prostatectomy (RP) and external beam radiation therapy (EBRT) Data on HDR in combination with
EBRT demonstrate excellent 5- and 10-year outcomes and increasing data on HDR monotherapy demonstrate similar
excellent prostate cancer treatment outcomes
Superior efficacy
In a matched-pair analysis of low- to intermediate-risk patients with localized prostate cancer permanent seed
implants were shown to produce significantly better prostate cancer control rates at 5 years than traditional EBRT
Flexible synergistic treatment
Both permanent (LDR seed therapy) and temporary (HDR) implants have shown to work synergistically (as a lsquoboostrsquo)
with EBRT and with androgen deprivation therapy (ADT) in higher risk patients
LDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy Well tolerated with minimized side effects
Minimizes dose to surrounding tissuespares surrounding organs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) ensures radiation is precisely targeted to the area
of the tumor eliminating unnecessary exposure and damage to surrounding healthy tissues and organs
Use of HDR as a lsquoboostrsquo after EBRT allows dose escalation to target areas whilst minimizing exposure to healthy
tissues and organs
Minimizes toxicity and side effects
Patients receiving prostate brachytherapy (LDR seed therapy and HDR brachytherapy) suffer significantly decreased
side effects such as bowel function and bother and sexual dysfunction In addition prostate brachytherapy
demonstrates better urinary incontinence rates compared to RP and EBRT
Urinary function
Urinary function is affected by all radiotherapy and surgical procedures in localized prostate cancer Prostate
brachytherapy (LDR seed therapy and HDR brachytherapy) may result in transient urinary function issues that
generally resolve rapidly ndash consistent with the working of the radiation with lower longer-term urinary issues compared
to RP
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
Prostate brachytherapy Patient-centered with minimized impact on QoL
Minimally invasive shorter recovery time
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) avoids the physical and emotional trauma
potential blood loss and longer hospitalization associated with a major surgical procedure such as RP
Recovery from prostate brachytherapy (LDR seed therapy and HDR brachytherapy) is significantly quicker
(2ndash3 days) compared to RP (4ndash6 weeks) which means patientsrsquo lives are not put on hold
Shorter treatment duration ndash reduced disruption to daily life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) placement is direct to the tumor site so the
treatment can be completed in a day or days on an outpatient basis compared to a period of weeks with EBRT
Lower personal and hospital costs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy ) is a short outpatient procedure completed in 1-2
days This makes it less intrusive on daily life and lowers personal (and hospital) costs associated with the multiple
treatments sessions of EBRT and lengthy RP recovery time
Minimal disruption to patientsrsquo quality of life
Studies using specific QoL scales demonstrate that brachytherapy is generally associated with minimal impact on
HRQoL with respect to urinary sexual and bowel function and with a favorable HRQoL profile compared to EBRT and
RP and even newer techniques such as Da Vinci and cryotherapy
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Cost effectiveness vs frequently used alternative modalities
Prostate brachytherapy Optimized healthcare resources
Like IMRT and proton therapy brachytherapy delivers high dose to tumor targets while limiting damage to healthy
tissues but brachytherapy only needs low investment and maintenance costs making brachytherapy more attractive
for cost-effectiveness considerations and for healthcare resource investment decisions
Modern radiotherapy with low investment costs
Brachytherapy has been shown to be a cost-effective alternative to surgery EBRT and newer technologies such as
IMRT or proton therapy
A recent review by the ICER group in the USA confirmed brachytherapy as a lsquohigh valuersquo treatment modality compared
to approaches such as IMRT and protons
Use of brachytherapy for appropriate patients allows a department to free up time for Linac use reducing congestion
maximizing patient flow and optimizing department resources
Brachytherapy offers opportunity to maximize radiotherapy department resources
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
LDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
Prostate brachytherapy Well tolerated with minimized side effects
Minimizes dose to surrounding tissuespares surrounding organs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) ensures radiation is precisely targeted to the area
of the tumor eliminating unnecessary exposure and damage to surrounding healthy tissues and organs
Use of HDR as a lsquoboostrsquo after EBRT allows dose escalation to target areas whilst minimizing exposure to healthy
tissues and organs
Minimizes toxicity and side effects
Patients receiving prostate brachytherapy (LDR seed therapy and HDR brachytherapy) suffer significantly decreased
side effects such as bowel function and bother and sexual dysfunction In addition prostate brachytherapy
demonstrates better urinary incontinence rates compared to RP and EBRT
Urinary function
Urinary function is affected by all radiotherapy and surgical procedures in localized prostate cancer Prostate
brachytherapy (LDR seed therapy and HDR brachytherapy) may result in transient urinary function issues that
generally resolve rapidly ndash consistent with the working of the radiation with lower longer-term urinary issues compared
to RP
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
Prostate brachytherapy Patient-centered with minimized impact on QoL
Minimally invasive shorter recovery time
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) avoids the physical and emotional trauma
potential blood loss and longer hospitalization associated with a major surgical procedure such as RP
Recovery from prostate brachytherapy (LDR seed therapy and HDR brachytherapy) is significantly quicker
(2ndash3 days) compared to RP (4ndash6 weeks) which means patientsrsquo lives are not put on hold
Shorter treatment duration ndash reduced disruption to daily life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) placement is direct to the tumor site so the
treatment can be completed in a day or days on an outpatient basis compared to a period of weeks with EBRT
Lower personal and hospital costs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy ) is a short outpatient procedure completed in 1-2
days This makes it less intrusive on daily life and lowers personal (and hospital) costs associated with the multiple
treatments sessions of EBRT and lengthy RP recovery time
Minimal disruption to patientsrsquo quality of life
Studies using specific QoL scales demonstrate that brachytherapy is generally associated with minimal impact on
HRQoL with respect to urinary sexual and bowel function and with a favorable HRQoL profile compared to EBRT and
RP and even newer techniques such as Da Vinci and cryotherapy
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Cost effectiveness vs frequently used alternative modalities
Prostate brachytherapy Optimized healthcare resources
Like IMRT and proton therapy brachytherapy delivers high dose to tumor targets while limiting damage to healthy
tissues but brachytherapy only needs low investment and maintenance costs making brachytherapy more attractive
for cost-effectiveness considerations and for healthcare resource investment decisions
Modern radiotherapy with low investment costs
Brachytherapy has been shown to be a cost-effective alternative to surgery EBRT and newer technologies such as
IMRT or proton therapy
A recent review by the ICER group in the USA confirmed brachytherapy as a lsquohigh valuersquo treatment modality compared
to approaches such as IMRT and protons
Use of brachytherapy for appropriate patients allows a department to free up time for Linac use reducing congestion
maximizing patient flow and optimizing department resources
Brachytherapy offers opportunity to maximize radiotherapy department resources
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
Prostate brachytherapy Patient-centered with minimized impact on QoL
Minimally invasive shorter recovery time
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) avoids the physical and emotional trauma
potential blood loss and longer hospitalization associated with a major surgical procedure such as RP
Recovery from prostate brachytherapy (LDR seed therapy and HDR brachytherapy) is significantly quicker
(2ndash3 days) compared to RP (4ndash6 weeks) which means patientsrsquo lives are not put on hold
Shorter treatment duration ndash reduced disruption to daily life
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) placement is direct to the tumor site so the
treatment can be completed in a day or days on an outpatient basis compared to a period of weeks with EBRT
Lower personal and hospital costs
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy ) is a short outpatient procedure completed in 1-2
days This makes it less intrusive on daily life and lowers personal (and hospital) costs associated with the multiple
treatments sessions of EBRT and lengthy RP recovery time
Minimal disruption to patientsrsquo quality of life
Studies using specific QoL scales demonstrate that brachytherapy is generally associated with minimal impact on
HRQoL with respect to urinary sexual and bowel function and with a favorable HRQoL profile compared to EBRT and
RP and even newer techniques such as Da Vinci and cryotherapy
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Cost effectiveness vs frequently used alternative modalities
Prostate brachytherapy Optimized healthcare resources
Like IMRT and proton therapy brachytherapy delivers high dose to tumor targets while limiting damage to healthy
tissues but brachytherapy only needs low investment and maintenance costs making brachytherapy more attractive
for cost-effectiveness considerations and for healthcare resource investment decisions
Modern radiotherapy with low investment costs
Brachytherapy has been shown to be a cost-effective alternative to surgery EBRT and newer technologies such as
IMRT or proton therapy
A recent review by the ICER group in the USA confirmed brachytherapy as a lsquohigh valuersquo treatment modality compared
to approaches such as IMRT and protons
Use of brachytherapy for appropriate patients allows a department to free up time for Linac use reducing congestion
maximizing patient flow and optimizing department resources
Brachytherapy offers opportunity to maximize radiotherapy department resources
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
Cost effectiveness vs frequently used alternative modalities
Prostate brachytherapy Optimized healthcare resources
Like IMRT and proton therapy brachytherapy delivers high dose to tumor targets while limiting damage to healthy
tissues but brachytherapy only needs low investment and maintenance costs making brachytherapy more attractive
for cost-effectiveness considerations and for healthcare resource investment decisions
Modern radiotherapy with low investment costs
Brachytherapy has been shown to be a cost-effective alternative to surgery EBRT and newer technologies such as
IMRT or proton therapy
A recent review by the ICER group in the USA confirmed brachytherapy as a lsquohigh valuersquo treatment modality compared
to approaches such as IMRT and protons
Use of brachytherapy for appropriate patients allows a department to free up time for Linac use reducing congestion
maximizing patient flow and optimizing department resources
Brachytherapy offers opportunity to maximize radiotherapy department resources
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
Prostate brachytherapy Solid heritage
Heritage
LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer
Global acceptance
The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer
Evidence based
Since the 1960s there have been over 2500 publications on the use of brachytherapy in the management of localized prostate cancer
Continued advances
Transrectal ultrasonography (TRUS) guidance template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure
Constant technique development means better patient QoL
Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treatingprostate cancer This offers all benefits of LDR seed therapy such as short course (2 days) and precision targeting but with an even more preferable toxicity profile leading to greater quality of life for patients
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Key message citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Maximal conformity ndash precise targeting
Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site minimizing healthy tissue damage and so reducing side effects HDR brachytherapy provides superior conformity compared to other modern techniques such as IMRT and tomotherapy
1Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
4Poumltter R Image-guided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991(2)141-6
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Tailored treatment
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Nobes J Khaskar S Hawkins M et al Novel prostate brachytherapy technique Improved dosimetric and clinical outcome Radiother Oncol 200888121-126
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Modern techniques
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
3 Zelefsky M Yamada Y Cohen G et al Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200767(1)65-70
4 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
6 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Minimally invasive
1Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
2Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3Ferrer M Suareze J Guedea et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-432
4Prostate Cancer Charity Available at httpwwwprostatecancerorgukinfoprostate_cancertreatment_brachytherapyasp Accessed 301009
Back to key messages
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Maximal conformity ndash precise targeting (contrsquod)
Quality control
1Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Demonstrated efficacy
LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Henry AM Al-Qaisieh B Gould K et al Outcomes following iodine-125 monotherapy for localized prostate cancer the results of Leeds 10-year single-center brachytherapy experience Int J Radiat Oncol Biol Phys 201076(1)50-56
5Hinnen KA et al Loose seeds versus stranded seeds in I-125 prostate brachytherapy Differences in clinical outcome Radiother Oncol 2010 (E Pub ahead of press)
6Koukourakis G Kelekis N Armonis V Kouloulias V Brachytherapy for prostate cancer a systematic review Adv Urol 2009327945
7Pisansky TM Gold DG Furutani KM et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-72
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Equivalent outcomes
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Batterman J Boon T and Moerland A Results of permanent prostate brachytherapy 13 years of experience at a single institution
Radiother Oncol 20047123-28
4Sylvester J Grimm P Wong J et al Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients Brachyther 20098105-180 Abstr PO101
5 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
6Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
7Ragde H Blasko J and Grimm P et al Brachytherapy for clinically localized prostate cancer Results at 7- and 8-year follow up Semin Surg Oncol 199713438-443
8Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Demonstrated efficacy (contrsquod)
Superior efficacy
1Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
Flexible synergistic treatment
1Sylvester J Grimm P Blasko J et al 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy Seattle experience Int J Radiat oncol Biol Phys 200767(1)57-64
2Merrick G Butler W Wallner K et al Impact of supplemental external beam radiotherapy andor androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 200561(1)32-43
3Kovaacutecs G Poumltter R Lock T et al GECESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer Radiother Oncol 200574137-148
4Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
5Hoskin PJ Motohashi K Bownes P et al High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer initial results of a randomised phase three trial Int J Radiother Oncol 200784(2)114-20
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapyWell tolerated with minimized side effectsLDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue minimizing the bowel bladder and sexual function side effects which would otherwise impact quality of life
In HDR brachytherapy precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs and thus less toxicity and side effects such as bowel and bladder problems
1 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
2Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
3Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
Minimizes dose to surrounding tissuesspares surrounding organs
1 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
2 Phan T Syed A Puthawala A et al High dose rate brachytherapy as a boost for the treatment of localized prostate cancer Jnl Urol 2006177123-127
3 Fatyga M Williamson JF Dogan N et al A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer a radiobiological modeling study Med Phys 200936(9)3995-4006
4 Hermesse J Biver S Jansen N et al A dosimetric selectivity intercomparison of HDR brachytherapy IMRT and helical tomotherapy in prostate cancer radiotherapy Strahlenther Onkol 2009185736-42
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Minimizes toxicity and side effects optimizes QoL
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Henderson A Laing R and Langley S Quality of life following treatment for early prostate cancer Does low dose rate (LDR) brachytherapy offer a better outcome A review Eur Urol 200445134-141
3 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
4 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
5 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapyWell tolerated with minimized side effects (contrsquod)
Urinary function
1 Moule R and Hoskin P Non-surgical treatment of localized prostate cancer Surg Oncol 200918255-267
2 Pickles T Keyes M Morris W et al Brachytherapy or conformal external radiotherapy for prostate cancer A single institution matched-pair analysis Int J Radiat Oncol Biol Phys 201076(1)43-49
3 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
4 Pinkawa M Asadpour B Piroth M et al Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer ndash a matched-pair comparison Radiother Oncol 200991225-231
5 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapyPatient-centered with minimized impact on QoL
Prostate brachytherapy allows for significantly shorter treatment times often on an out-patient basis compared to EBRT ndash day(s) compared to weeks and shorter recovery times compared to radical prostatectomy with minimal impact on functional outcomes and quality of life
1Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years
Urol 200769338-342
3Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer
Radiother Oncol 200784(2)135-139
4Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
5Grills I Martinez A Hollander M et al High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds Jnl Urol 20041711098-1104
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Minimally invasive shorter recovery time
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Hall J Boyd J Lippert M et al Why patients choose prostatectomy or brachytherapy for localized prostate cancer Results of a descriptive survey Urol 200361402-407
3 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Shorter treatment duration ndash reduced disruption to daily life
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
4 Prostate Brachytherapy Advisory Group Available at httpwwwprostatebrachytherapyinfonethow_does_ldr_brachytherapy_compareasp Accessed 061109
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Reduced side effects and impact on functional outcomes
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Stone N and Stock R Long-term urinary sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years Urol 200769338-342
3 Ash D Bottomley D al-Qaisieh B et al A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer Radiother Oncol 200784(2)135-139
4 Roeloffzen EM Lips IM van Gellekom MP et al Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]
5 Ferrer M Suarez JF Guedea F et al Health-related quality of life 2 years after treatment with radical prostatectomy prostate brachytherapy or external beam radiotherapy in patients with clinically localized prostate cancer Int J Radiat Oncol Biol Phys 200872(2)421-32
6 Malcolm JB et al Quality of life after open or robotic prostatectomy cryoablation or brachytherapy for localized prostate cancer J Urol 2010 183 1822-1829
Back to key messages
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapyPatient-centered with minimized impact on QoL (contrsquod)
Lower personal and hospital costs
1 Frank S Pisters L Davis J et al An assessment of quality of life following radical prostatectomy high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer Jnl Urol 20071772151-2156
2 Hoskin P and Bownes P Innovative technologies in radiation therapy Brachytherapy Semin Radiat Oncol 200616209-217
3 Buron C Le Vu B Cosset J-M et al Brachytherapy versus prostatectomy in localized prostate cancer Results of a French multicenter prospective medico-economic study Int J Radiat Oncol Biol Phys 200767(3)812-822
Back to key messages
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Optimized healthcare resources
Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources delivering clinical efficacy and patient-centered therapy on a cost-effective basis
1Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Modern radiotherapy with low investment costs
1 Poumltter R Imagendashguided brachytherapy sets benchmarks in advanced radiotherapy Radiother Oncol 200991141-146
2Institute for Clinical and Economic Review Management Options for Low-Risk Prostate Cancer A Report on Comparative Effectiveness and Value 2010
Back to key messages
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapyOptimized healthcare resources (contrsquod)
Cost effectiveness vs frequently used alternative modalities
1ICER httpwwwicer-revieworgindexphpfinal-harmonized-report-010509html Accessed 110110
2Brandeis J Pashos C Henning J et al A nationwide charge comparison of the principal treatments for early stage prostate carcinoma Can 2000891792-9
Brachytherapy offers opportunity to maximize radiotherapy department resources
1 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
Back to key messages
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Solid heritage
Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Koukourakis G Kelekis N Armonis V et al Brachytherapy for prostate cancer Adv Urol 2009 Article ID327945
3 Stock R Cesaretti J and Stone N Disease-specific survival following the brachytherapy management of prostate cancer Int J Radiat Oncol Biol Phys 200664(3)810-816
Heritage
1 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
2 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Solid heritage (contrsquod)
Global acceptance
1 European Association of Urology Guidelines on Prostate Cancer Available athttpwwwuroweborgfileadmintx_eauguidelines2009FullProstate_Cancerpdf Accessed 021109
2 American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer Available athttpwwwauanetorgcontentguidelines-and-quality-careclinical-guidelinesmain-reportsproscan07contentpdf Accessed 021109
3 National Health and Medical Research Council Clinical Practice Guidelines Evidence-based recommendations for the management of localised prostate cancer Available at httpwwwnhmrcgovaupublicationssynopsescp88synhtm Accessed 041109
Evidence based
1 Pubmed Search Prostate cancer brachytherapy Available at wwwncbinlmnihgovpubmed Accessed 190110
Continued advances
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
Back to key messages
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Prostate brachytherapy Solid heritage (contrsquod)
Constant technique development means better patient QoL
1 Holloway C Hsu I Albert C et al Prostate brachytherapy In Devlin Brachytherapy Applications and techniques Philadelphia PA LWW 2007
2 Pisansky T Gold D Furutani K et al High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer Mayo Clin Proc 200883(12)1364-1372
3 Grimm P and Sylvester J Advances in brachytherapy Rev Urol 20046 (Suppl 4)S37-S48
Back to key messages
Back to citations
Back to citations
Back to citations
Back to citations
Back to citations
![PREPARING FOR PROSTATE BRACHYTHERAPYradonc.ucla.edu/workfiles/Brachytherapy/Prostate-Brachytherapy.pdf · our anesthesia department]. If you are on blood thinners such as Warfarin](https://img.pdfslide.us/doc/110x75/5fcd8d6f8dc5f50d6b612393/preparing-for-prostate-our-anesthesia-department-if-you-are-on-blood-thinners.jpg)
