The American Society of Clinical Oncology (ASCO) and Cancer Care Ontario issued a joint update to guidelines for brachytherapy in men with prostate cancer to take into account new evidence.1

An Update Panel conducted a directed systematic literature review to identify recent randomized controlled trials that compared dose-escalating external beam radiotherapy (EBRT) with brachytherapy in men with prostate cancer. The Update Panel assessed results from 5 randomized controlled trials.

This analysis yielded some adjusted guidelines on brachytherapy in men with prostate cancer. Recommendations include that for patients with low-risk disease who require or elect active treatment, low-dose brachytherapy (LDR) alone, EBRT alone, and/or radical prostatectomy should be offered.

In patients with intermediate-risk disease who choose EBRT with or without androgen-deprivation treatment, brachytherapy boost (LDR or high-dose brachytherapy [HDR]) should be offered.

Recommendations state that LDR alone can be offered to patients at low-intermediate risk. Clinicians should offer brachytherapy boost (LDR or HDR) to patients at high risk who are undergoing EBRT and androgen-deprivation therapy.

These recommendations state that iodine-125 and palladium-103 are reasonable options for isotopes in patients undergoing LDR brachytherapy. Notably, these guidelines made no recommendation against cesium-131 or HDR monotherapy.

Finally, these recommendations encourage patients to participate in clinical trials to test new or targeted treatment options.

Reference

1. Chin J, Rumble RB, Kollmeier M, et al. Brachytherapy for patients with prostate cancer: American Society of Clinical Oncology/Cancer Care Ontario joint guideline update. J Clin Oncol. 2017 Mar 27. doi: 10.1200/JCO.2016.72.0466 [Epub ahead of print]