UroToday - Brachytherapy for localized prostate cancer is a mature treatment option. Over 25 years of clinical experience and published results of 10-15 years follow up in peer-reviewed journals support its role in our current armamentarium.
There are however several questions still open regarding prostate low dose rate (LDR) brachytherapy: proper selection of patients for monotherapy versus combination of brachytherapy and external radiation with or without the addition of androgen deprivation therapy, preferred isotope, iodine or palladium and several issues regarding technical aspects of the treatment, for example whether free seeds are better than stranded ones. Clinicians and researchers feel strongly regarding the planning for the procedure: whether to employ a variety of preplanning methods or to practice intraoperative on site planning systems.
We at the Tel Aviv Sourasky Medical Center in Israel had a unique situation, where we switched from one method to the other and prospectively followed several hundred patients. Our previously published data regarding the 30 days postoperative CT-based dosimetry strongly support the intraoperative methodology. However, these data need to be translated into clinical aspects - mainly PSA kinetics post implant and PSA based freedom from failure. The current publication reveals our PSA kinetics data for the first years post-treatment. The rate of PSA decline and the nadir values reached in the intraoperative group of patients was substantially and significantly better than in the preplanned group. Since PSA kinetics and absolute values have been shown to bear important clinical outcomes on clinical disease free survival periods, we believe our current data is crucial for the substantiation of the intraoperative methodology as the favorable one to be used. We anticipate that long-term PSA based freedom from failure rates among our groups will provide further evidence for the superiority of the intraoperative method and will speed the obsolesce of the former.
Haim Matzkin, MD, et al. as part of Beyond the Abstract on UroToday. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.
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