Video: Which Patients are Candidates for HDR Brachytherapy? | Ask a Prostate Expert, Dr. Jeffrey Demanes

Ask a Prostate Expert | Transcription

Alex: The next question I have is really, "What is the best patient profile for brachy?" Is everyone who has, you know, localized disease, is brachy good for them? Is there any candidate where brachy is not the best option? 

Dr. Demanes: Most patients with localized prostate cancers are candidates for brachytherapy. 

There are patients with very early disease who can undergo active surveillance, or just watch and see how they do, monitor their PSA, and other tests. So maybe they don't need any treatment, but as they progress along the road of disease progression, they come to a point where they make a decision to have treatment, those patients are excellent candidates for brachytherapy alone without any external beam, without any adjuvant hormones or other therapy. That's the low-risk group. 

The intermediate-risk group patients can go directly to therapy. Most of them would be candidates for brachytherapy alone or external beam alone, or surgery, and those are all modalities that are appropriate, but that group of patients are the ones that we got 95%, 10 year, PSA progression-free survival with very low complication rates. 

The patients who have the high-risk, the more aggressive, they typically get a combination of external beam, a brachytherapy boost (the additional high dose into the delicate area), and they're often treated with hormones. So they would get a sort of a triple threat, a triple combination. Now, there are some patients in the high-risk group that have relatively low volume disease. I think we can treat those with brachytherapy alone and avoid all the other treatments because the less you can do and get the same cure rate, the better because you'll have lower complication rates. 

You can also treat patients who have recurrent disease of the prostate having previously had a seed implant or external beam and the disease comes back and then you can choose to do this brachytherapy because it's so well confined, you can retreat the patient. It has to be done carefully and with the knowledge that there are more side effects or risks for more side effects when you're doing retreatment of anything, but it is a highly effective way of salvaging patients who thought they had no treatment option for a cure, but in fact they do. And you can treat the whole gland or you can just treat the target that you know is positive. So salvage is another setting for brachytherapy, HDR brachytherapy. 

Alex: So if you would like more information about anything we talked about, you can go ahead and contact our Helpline team and they will be available to talk to you. The number is at our website, PCRI.org and you can look up other information on prostate cancer treatments. And if you like this video go ahead and give us a thumbs up. The reason that thumbs-up matter is because that lets Google know that this video is helpful to you and it can help other patients and we get on a suggested video list. Subscribe to our Youtube channel if you would like more information in general about prostate cancer. We cover every topic we could possibly think of and we hope you have a great week.