Mira Keyes, MD, FRCPC, FABS

Mira Keyes, MD, FRCPC, FABS

British Columbia Cancer Agency (BCCA)

Vancouver, British Columbia, Canada

Mira Keyes, MD, FACS, 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. Mira Keyes is one of the founders of the British Columbia Cancer Agency (BCCA) Provincial Prostate Brachytherapy Program (1998), past program Quality Assurance Head, and since 2006, a Provincial Program Head. Dr. Keyes is a former Residency Training Program Director in Radiation Oncology at UBC, and past Royal College examiner in Radiation Oncology.  She is vice chair of the group developing Brachytherapy Diploma Certification with Royal College of Physicians and Surgeon of Canada, for the purpose of credentialing brachytherapy training process at a national level.

She is an elected board member for ABS (American Brachytherapy Society) and member of the editorial board for Brachytherapy Journal. She is a member of CARO (Canadian Association for Radiation Oncology), CBG (Canadian Brachytherapy Group) ASTRO and ESTRO. Dr. Keyes has been an invited speaker at many national and international conferences; she is an author of over fifty peer reviewed articles and recipient of many peer review grants.  She has a large GU and Head and neck practice.

She is a recipient of several UBC awards:  Mentorship Award (2018), Teaching Award (2017), CanMeds of Excellence Award (2014) and AD McKenzie UBC Department of Surgery Clinical Teaching Award 2017,  in 2019, nominated for Royal College of Physicians and Surgeons of Canada Mentorship Award. She is a CARO and BC Cancer wellness committee chair.

Talks by Mira Keyes, MD, FRCPC, FABS

Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer

Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer

Posted by ,  and  | Feb 2025

H1: LDR Brachytherapy for the Treatment of Prostate Cancer

E. 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, and Steven M. Kurtzman, MD, Director of Prostate Brachytherapy, Western Radiation Oncology, Mountain View, California, 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 presents his strategy for bringing prostate brachytherapy programs to communities and reasons to perform it at ASCs, including fostering a genuine collaboration between urologists and radiation oncologists. Overall, he 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

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

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Point-Counterpoint: Surgery vs. Brachytherapy for Intermediate and High-Risk Prostate Cancer – Brachytherapy

Point-Counterpoint: Surgery vs. Brachytherapy for Intermediate and High-Risk Prostate Cancer – Brachytherapy

Posted by | Jul 2023

Mira Keyes, MD, FRCPC, presents an informative discussion on the benefits of brachytherapy compared to surgery and external beam radiation for prostate cancer treatment. She highlights the elusive outcomes and challenges of current treatments, emphasizing the importance of patients’ quality of life and cost considerations.

Dr. Keyes explores how brachytherapy outperforms surgery in terms of PSA (prostate-specific antigen) and metastasis-free survival outcomes in high-risk and unfavorable intermediate-risk patients. These findings suggest that brachytherapy can effectively target and control aggressive forms of prostate cancer.

Additionally, she addresses the misconception that brachytherapy is only suitable for certain risk groups, explaining its effectiveness across all risk stratifications. This broader applicability of brachytherapy allows more patients to benefit from this targeted treatment option, potentially reducing the need for invasive surgeries.

The presentation also delves into the topic of toxicity, showcasing the manageable side effects of brachytherapy compared to surgery. By minimizing damage to surrounding tissues, brachytherapy reduces the risk of complications such as urinary incontinence and erectile dysfunction, which are more commonly associated with surgery.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Surgery vs. Brachytherapy for Intermediate and High-Risk Prostate Cancer – Surgery.”

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Brachytherapy: The Royal Flush of Radiation Treatment for Men with High-Risk Prostate Cancer

Brachytherapy: The Royal Flush of Radiation Treatment for Men with High-Risk Prostate Cancer

Posted by | Oct 2022

Mira Keyes, MD, FRCPC, 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), discusses the benefits of prostate brachytherapy (PB) for men with high- and very high-risk prostate cancer. Dr. Keyes explains PB has excellent long-term outcomes (with the best cure rates of all radiation therapy [RT] treatments), requires less androgen deprivation therapy (ADT), has less downstream toxicity and lower cost than alternatives, calling it a “royal flush” treatment when used as a boost with external beam radiation therapy (EPRT).

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