Current status of prostate brachytherapy in Japan
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INVITED REVIEW
Current status of prostate brachytherapy in Japan Atsunori Yorozu1 Received: 14 February 2020 / Accepted: 18 May 2020 © Japan Radiological Society 2020
Introduction
LDR brachytherapy
Prostate cancer has been a common malignancy in men in Japan. Current common treatment options for early-stage prostate cancer include radical prostatectomy, external beam radiation therapy (EBRT), low-dose-rate (LDR) brachytherapy and high-dose-rate (HDR) brachytherapy, androgen deprivation therapy (ADT), and active surveillance. Permanent seed implantation, also known as LDR brachytherapy, is a form of radiotherapy in which tiny radioactive sources are placed into the prostate to provide a steady dose of radiation over a few months. With results published in 2012, the Prostate Cancer Results Study Group undertook a lot of studies into clinically useful comparisons and completed the first large-scale comprehensive review of the literature comparing risk-stratified patients with long-term follow-up by treatment option [1]. The literature review demonstrated that brachytherapy provides superior outcomes in patients with low-risk disease in terms of biochemical prostate-specific antigen (PSA) free progression. Additionally, the combination of EBRT and brachytherapy was shown to be superior to EBRT or surgery alone for intermediate-risk disease. Combination therapies involving EBRT and brachytherapy plus or minus ADT appear superior in terms of biochemical control as compared to more localized treatments such as brachytherapy alone, surgery alone, or EBRT alone for high-risk patients. This review covers the current status of LDR and HDR brachytherapy including recent evidence published from Japan.
The use of permanent iodine-125 seed implantation has become a popular treatment option in Japan. It is estimated that since 2003, about 45,000 patients have received this treatment in more than 110 institutions nationwide. LDR brachytherapy is a highly effective and efficacious treatment with a favorable side effect profile and has a role in the treatment of localized prostate cancers. It is a short-time procedure where tiny radioactive sources are implanted in the prostate to eradicate the cancer (Fig. 1). It has a long and proven track record with data demonstrating it to be extremely effective when used alone in low- and favorable intermediate-risk prostate cancer per the National Comprehensive Cancer Network (NCCN) Guidelines classification. (Favorable intermediate-risk risk is defined with Gleason score 3 + 4 = 7, and percentage of positive biopsy cores
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