E. David Crawford, MD; Mira Keyes, MD, FRCPC; Steven M. Kurtzman, MD, presented “Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer” on January 16, 2025.
How to cite: Crawford, David E; Keyes, Mira; Kurtzman, Steven M. “Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer.” January 31, 2025. Accessed Mar 2025. https://grandroundsinurology.com/expanding-treatment-options-at-ambulatory-surgical-centers-ldr-brachytherapy-for-prostate-cancer/
Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer
H1: LDR Brachytherapy for the Treatment of Prostate Cancer
Drs. Crawford, Keyes, and Kurtzman discuss low-dose rate (LDR) brachytherapy as a treatment for prostate cancer.
H2: Benefits of Brachytherapy for Prostate Cancer
Dr. Crawford explains that brachytherapy gets excellent results in prostate cancer patients across different risk and demographic groups, Gleason scores, and PSA levels. Dr. Keyes then shares the clinical rationale for performing LDR brachytherapy in ambulatory surgical centers (ASC).
H3: Prostate Cancer Treatment Strategies: Benefits of Brachytherapy on Different Risk Groups
Dr. Keyes explains that patients eligible for the low-dose rate brachytherapy, also referred to as seed implants, include all prostate cancer patients. She highlights that hormone treatment duration is significantly shorter when brachytherapy is included in the treatment plan. For example, in high risk prostate cancer patients, randomized controlled trials show that six months of androgen deprivation therapy (ADT) is enough when combined with brachytherapy. Avoiding 12 or 24 months of ADT, which is necessary when external beam radiation is utilized, helps decrease unwanted side effects for patients.
Finally, Dr. Keyes discusses toxicity in brachytherapy treatments and asserts that data cited on this topic often utilize older studies. Dr. Keyes emphasizes considering results from more recent publications.
H4: Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer
Next, Dr. Kurtzman discusses how to set up high quality programs in ambulatory surgical centers and his opinion that LDR brachytherapy is an underutilized treatment for prostate cancer. He examines LDR brachytherapy’s high cure rates, low-long term complication rates, convenience for patients, financial benefits, and reasons LDR brachytherapy is not as prevalent.
Additionally, Dr. Kurtzman highlights how incorporating LDR brachytherapy into urology practices and ASCs fosters collaboration between urologists and radiation oncologists
Conclusion
This 20-minute discussion concludes with Dr. Crawford’s comments on the importance of multidisciplinary care for better patient outcomes and strong interdisciplinary collaboration between urologists and radiation oncologists.
Appendix
Further information about the presenters:
- David Crawford, MD, Professor of Urology, University of California, San Diego, California.
- Mira Keyes, MD, FRCPC, Clinical Professor Radiation Oncology, University of British Columbia, BC Cancer, Vancouver Cancer Centre, Vancouver BC, Canada.
- Steven M. Kurtzman, MD, Director of Prostate Brachytherapy, Western Radiation Oncology, Mountain View, California.
Dr. Keyes also provided analysis of some recent studies that review:
- Results showing 77% of patients in low and intermediate risk groups have PSA equal to or less than 0.2 five years after treatment with 1-2% recurrence, suggesting brachytherapy is very consistent with very low risk of prostate cancer recurrence
- The ASCENDE RT trial that compared external beam radiation and LDR brachytherapy boat or dose-escalated external beam boost, and LDR boost in intermediate and high risk patients. Trial results showed a huge difference in PSA outcomes
- If hormone treatment is needed for high risk prostate cancer patients who are also treated with external beam radiation with brachytherapy boost
- Outcomes of intermediate and high risk patient groups treated with brachytherapy versus radical prostatectomy that showed positive outcomes for patients treated with brachytherapy, particularly in high risk groups
- A study evaluating outcomes of patients with very high risk groups with Gleason 9 and 10 treated with prostate brachytherapy boost, external beam radiation, or prostatectomy. The study showed very favorable outcomes for patients treated with brachytherapy
To hear more from these Experts click here.
ABOUT THE AUTHOR
Researcher-physician E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States.
Mira Keyes, MD, FRCPC, FABS, is a Clinical Professor at the University of British Columbia (UBC) and a radiation oncologist at the Vancouver Centre of the British Columbia Cancer Agency (BCCA). Dr. Keyes has a wide range of research interests, including Prostate Brachytherapy, Genito-Urinary Oncology, Breast Cancer, Postgraduate Medical Education, and Patient Communication.
Dr. Keyes received her MD at the University of Novi Sad in Yugoslavia, Serbia. Dr. Keyes then received her FRCPC Radiation Oncology from the Royal College of Physicians of Canada. Dr. Keyes completed her fellowship at the Royal College of Physicians of Canada for Radiation Oncology, in the Vancouver Cancer Center.
Dr. Kurtzman received a Bachelor of Arts from Cornell University, New York, and received his medical degree from Case Western Reserve University School of Medicine, Cleveland, Ohio. He completed his residency at the University of Pennsylvania, Philadelphia and joined WRO in 1998. Dr. Kurtzman is nationally renowned for his expertise in ‘real-time’ intraoperatively planned prostate brachytherapy. He has presented at multiple national meetings and has taught physicians on this advanced technique from around the globe.He is notable for performing implants all throughout the United States and has treated over 6000 patients over the past twenty years. He also serves on the medical advisory board of several medical device companies, helping to inform the development of new treatment techniques. He is the Director of Prostate Brachytherapy for Western Radiation Oncology.
