Can You Use Brachytherapy As a Focal Therapy? | Ask a Prostate Expert, Jeffrey Demanes, MD

Ask a Prostate Expert, Jeffrey Demanes, MD | Transcription

Alex: Now, when you're talking about targeted and focal brachy, how often do you see that? Is that something you have commonly done? Or is it… 

Dr. Demanes: It's something that is becoming of increasing interest. The results that we got, the 95% and the 99% disease control rates, were by treating the whole gland with a margin and making sure that any areas that were not appreciated on scans or by other biopsies or other means, those parts of the disease were treated. The surgeons have been doing some cryotherapy and HIFU (high-intensity focused ultrasound) and treating part of the gland and even lasering part of the gland as a way of trying to do something less than a radical prostatectomy.

So, people have been looking at radiation therapy in a similar way and the very best tool of doing that, in my opinion without question, is HDR brachytherapy because we can treat a quarter of the gland, half of the gland, the upper part, the lower part. You know, what are the outcomes going to be with focal therapy versus whole gland therapy? In all likelihood there will be some patients who have disease that you don't appreciate, so the control rates of the area you treat may be just as high, but they'll probably recur in another part of the prostate, so it has to be carefully decided with the patient based on the data that's available. There's not a lot of published data on focal therapy, but it's a very interesting concept to reduce urinary and sexual function side effects.