Radiation treatment of prostate cancers – the contemporary role of modern brachytherapy techniques

Life expectancy is rising and the population is ageing in most countries [1]. Prostate cancer (PCa) is the second commonest diagnosed malignancy and it is the fifth leading cause of cancer mortality in men, representing a public health burden worldwide. Furthermore, the majority of PCa (around 62%) is diagnosed in men over 65 years [2].
The use of the prostatic specific antigen (PSA) as a tool for monitoring PCa progression was approved in 1986 by the US Food and Drug Administration, and later, in 1994, its use was accepted also for PCa screening among men aged more than fifty years [3]. With the introduction of PSA testing, there have been a dramatic change in the stage of the disease at the time of diagnosis, with early stages being actually more predominant than advanced stages. Also, a trend in declining mortality due to PCa has been seem, and the major reasons for it may be the progression in the treatment option that include radical prostatectomy in its modalities, hormonal therapy, and a variety of new techniques of radiation therapy, besides the early detection [4].
A recent study comparing the incidence and treatment outcomes of PCa in countries with higher levels of human development and GDP (gross domestic product) per capita, has shown high variations geographically and over time, revealing a greater PCa incidence, but not accompanied by a greater mortality rate due to the disease. A substantial reduction in mortality rates was reported in most countries, except in some Asian countries and Eastern Europe, where mortality increased [5]. Possible explanations for this could be the early diagnosis and easier access to new treatment modalities. Differences in records of incidence and mortality can also be a confounding factor.
Several studies have already provided evidence for the efficacy of dose-escalation on biochemical control (BC) of PCa. Mature results from randomized trials have shown a direct relation between increasing the radiation dose given to the prostate and/or seminal vesicles and BC; however, randomized data comparing different methods of dose escalation are sparse [6,7,8,9].
Traditionally, brachytherapy for the treatment of PCa has been performed using low-dose-rate (LDR) as an effective single modality treatment for low- and intermediate-risk disease, or as a boost to external beam radiation (EBRT) for intermediate and high-risk localized tumors, with excellent results reported by both single and...


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