Antonio Cassio Assis Pellizzon*
A C Camargo Cancer Center, Sao Paulo, Brazil
*Corresponding author: Pellizzon ACA, A C Camargo Cancer Center, Sao Paulo, Brazil. Tel: +5511984470242; Email: firstname.lastname@example.org
Received Date: 13 December, 2016; Accepted Date: 13 December, 2016; Published Date: 19 December, 2016
Prostate Cancer (PCa) is the second commonest diagnosed malignancy and more than 62% of PCa are diagnosed in men over 65 years. It is the fifth leading cause of cancer mortality in men and represents a substantial public health burden, in special due to a rapidly aging population worldwide .
PSA as measurement for monitoring disease progression was approved in 1986 by the US Food and Drug Administration and late in 1994 it was endorsed its use for PCa screening among men aged more than fifty years .
There is a trend in declining mortality due to the disease and major reasons for it may be advances in PCa treatment options, including radical prostatectomy, hormonal therapy, and different and new techniques of radiation therapy .
Oceania, America, and European countries, followed by Africa, have the highest PCa incidence and the PCa mortality rates paralleled the incidence rates, in exception for Africa, where it was the highest. When comparing outcomes of countries with higher levels of human development and per capita GDP, we can observe a greater PCa incidence but not a greater mortality rate, . A possible explanation could be the access to new treatment modalities, early diagnosis and potential difference in health care systems for recording the causes of incidence and mortality.
Several studies provided evidence for the efficacy of dose-escalation on Biochemical Control (BC) of PCa. Mature results from randomized trials show a direct relation between increasing the radiation dose given to the prostate and/or seminal vesicles and BC, but randomized data comparing different methods of dose escalation are sparse [5-8].
Traditionally, brachytherapy for the treatment of PCa has been performed using low dose rate (LDR) and as a single modality for low and some 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 multi-institutional studies .
A recent randomized trial - ASCENDE-RT - compared two methods of dose escalation for intermediate- and high-risk prostate cancer. Patients had EBRT - pelvic (46 Gy) followed by a boost with EBRT (78 Gy) or LDR, plus 12 months of androgen deprivation therapy. As results the EBRT boost arm doubled the rate of biochemical failure, but no significant OS difference was observed between arms (paper in press - 10.1016/j.ijrobp.2016.11.026).
On the other hand, high dose rate brachytherapy (HDR) is most commonly used to boost EBRT when treating men with intermediate and high-risk PCa, with excellent long-term results . HDR is an important and effective method in achieving dose escalation in the radical radiotherapy PCa, with excellent BC when combined to EBRT . The combination of HDR with EBRT has the advantage of overall treatment time reduction and in increasing in the capability of work load of the linear accelerators, especially in developing countries, where waiting lists and lack of radiation oncology facilities are a reality. Furthermore, in locally advanced disease has also the possibility of including the seminal vesicles when they needed to be encompassed. HDR has also a potential biological advantage through the delivery of high doses per fraction . One prospective randomized trial with up to 10 years follow up has proved that HDR plus EBRT is more efficient than EBRT alone in terms of biochemical control with less acute rectal toxicity and improved quality of life .
Conversely, the use of HDR as single treatment modality, and even with single dose, has already been reported as favorable by several single-institution, but with short-term clinical outcomes [14,15]. Mature results of this technique are still missing in the literature, and furthermore, results of developing countries are inexistent.
In conclusion, PCa incidence is expected to increase in the future, further straining limited health care resources. Despite the fact that comparisons between series published are difficult due differences in the techniques and planning for both, EBRT, LDR and HDR, an appropriate allocation of resources for cancer prevention, early diagnosis, and curative treatments is required worldwide.
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Citation: Pellizzon ACA (2016) Current Status of Brachytherapy for Prostate Cancer. J Oncol Res Ther 2016: JONT-117. DOI: 10.29011/2574-710X. 000017