Mira Keyes, MD, FRCPC

Mira Keyes, MD, FRCPC

British Columbia Cancer Agency (BCCA)

Vancouver, British Columbia, Canada

Dr. Mira Keyes 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). She has also been the Head of the BCCA Prostate Brachytherapy Program since 2007. Dr. Keyes is one of the four founders of the Provincial BCCA Prostate Brachytherapy Program. She served as a Prostate Brachytherapy Program Quality Assurance Chair from 2003-2007, and as a UBC Radiation Oncology Residency Training Program Director from June 2001 to June 2006. From 2007-2012, she was a member of the Royal College of Physicians and Surgeons of Canada Examination Board in Radiation Oncology. From 2006-2009, she served as a UBC-BCCA Research Ethics Board Member. She is a member of BCCA provincial GU and Breast Tumour Groups. Her research interests include prostate brachytherapy outcomes, quality assurance, and translational research. She has been an invited speaker for CARO (Canadian Association of Radiation Oncology), CBG (Canadian Brachytherapy Group), ASTRO (American Society for Therapeutic Radiation Oncology), ABS (American Brachytherapy Society), and the Seattle Prostate Institute Advanced Brachytherapy Course.

Talks by Mira Keyes, MD, FRCPC

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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ADT and Brachytherapy: The Good, the Bad, and the Ugly

Posted by | Jun 2022

As part of a special course on brachytherapy for prostate cancer from the American Brachytherapy Society and Grand Rounds in Urology, Mira Keyes, MD, FRCPC, FABS, 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 pros and cons of using androgen-deprivation therapy (ADT) with brachytherapy to treat prostate cancer. After briefly discussing how ADT affects the tumor microenvironment, Dr. Keyes goes over the numerous clinical trials that have investigated how to combine external beam radiation together with hormone therapy. She explains that these trials found that the combination increases overall survival ~10-13% over ADT or EBRT alone, and longer ADT has a greater impact on OS, even with high radiation therapy dose. Dr. Keyes observes that ASCO considers brachytherapy a standard of care and recommends it be combined with ADT for unfavorable intermediate-risk and high-risk disease. She then considers the findings of ASCENDE-RT, the HDR UK trial, and the TROG 0.304 RADAR trial, all of which looked at the combination of ADT and brachytherapy, and discusses several ongoing randomized controlled trials on the role of ADT with prostate brachytherapy. Dr. Keyes also discusses a systematic literature review of ADT + prostate brachytherapy which concludes that the addition of ADT to brachytherapy provides no benefit to cancer-specific survival with ADT, and no benefit to overall survival with ADT, but does provide up to a 15% benefit to biochemical progression-free survival. She also notes that some believe dose escalation (prostate brachytherapy boost) may obviate the need for ADT in some high-risk patients. Dr. Keyes looks at a different meta-analysis which found that the addition of ADT to external beam radiation therapy provided a greater oncologic benefit than a brachytherapy boost and that there was a high probability that intermediate-risk and high-risk prostate cancer treated with EBRT + ADT would have superior overall survival to high-risk patients treated with EBRT + brachytherapy boost. Dr. Keyes argues that this paper misses the fact that the benefit of brachytherapy is that if brachytherapy is used, the duration of ADT can be reduced in unfavorable intermediate-risk and high-risk patients, which has a significant positive impact on quality of life and overall survival. She notes that ADT has numerous negative effects on quality of life, including erectile dysfunction, dementia, osteoporosis, metabolic syndrome, and more. Dr. Keyes particularly focuses on the negative cardiovascular effects from ADT, noting that observational data shows excess cardiovascular morbidity and mortality in patients on ADT with pre-existing cardiovascular disease. She concludes that ADT should be avoided in low- and intermediate-risk prostate cancer patients treated with monotherapy, that ADT for only 12 months in unfavorable intermediate- and high-risk patients is supported by randomized controlled trials, that ADT can be omitted in selected unfavorable intermediate- and high-risk patients, and that shorter ADT duration will improve quality of life and may increase overall survival by decreasing cardiovascular disease morbidity.

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Brachytherapy for Prostate Cancer

Posted by | Feb 2022

As part of a special course on brachytherapy for prostate cancer from the American Brachytherapy Society and Grand Rounds in Urology, Mira Keyes, MD, FRCPC, FABS, Clinical Professor at the University of British Columbia (UBC) and a radiation oncologist at the Vancouver Centre of the British Columbia Cancer Agency (BCCA), gives an overview of brachytherapy for prostate cancer (PCa), making a case against its declining use based on its efficacy. She begins by introducing the American Brachytherapy society, which was founded in 1978 to provide insight, rationale, and research into the use of brachytherapy in the treatment of both malignant and benign conditions. Dr. Keyes then describes how brachytherapy was performed with radium tubes when it was invented in 1901, and was then subsequently done with needles beginning in 1915. She concludes her short history by marking 1983 as the beginning of the modern era of prostate brachytherapy, thanks to advances in imaging capabilities. Dr. Keyes discusses data showing that brachytherapy is associated with better survival in patients with local to advanced cervical cancer. She then goes over the processes for high dose rate and low dose rate brachytherapy for PCa, focusing on the quick recovery, high cure rates, and minimal to no incontinence or sexual dysfunction as benefits for both treatments. Dr. Keyes shows data on brachytherapy utilization for PCa depicting its decline since 2003 due to robotic prostatectomy use, PSA screening changes, active surveillance low-risk treatment recommendation changes, and higher reimbursement for IMRT and robotic surgery. She also discusses data showing that 10% of US cancer care spending is on prostate cancer, with the highest procedure cost per patient going to robotic surgery. Dr. Keyes compares the use of brachytherapy in the US to that of Canada, stating that Canada’s increasing use is due to a reimbursement system that incentivizes brachytherapy, and the education of the public, residents, general practitioners, and urologists. She concludes that the benefits of brachytherapy support its use for localized PCa in the US.

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