Brian J. Moran Distinguished Lecture: Prostate Brachytherapy: Why Cure Doesn’t Seal the Deal

How to cite: Mirić G. Brian J. Moran Distinguished Lecture: Prostate Brachytherapy: Why Cure Doesn’t Seal the Deal. Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/brian-j-moran-distinguished-lecture-prostate-brachytherapy-why-cure-doesnt-seal-the-deal/

Summary

Grgur Mirić, MD, FACR, FABS, Director of the Schiffler Cancer Center, Men’s Health Center, and Cryosurgery Services, Wheeling Hospital, and Associate Professor of Radiation Oncology, Wheeling Jesuit University, Wheeling, West Virginia, delivers the Brian J. Moran Distinguished Lecture, reviewing long-term outcomes with prostate brachytherapy and arguing that achieving oncologic cure alone is not sufficient. He emphasizes both the durable effectiveness of brachytherapy and the importance of long-term men’s health management after treatment.

Dr. Mirić highlights the long-term efficacy of prostate brachytherapy across risk groups. Brachytherapy is a convenient and cost-effective treatment that can produce durable biochemical control when high-quality dose distributions are achieved. A key question addressed in brachytherapy development involved whether isotope selection influences outcomes in low-dose-rate monotherapy. A prospective randomized trial comparing palladium-103 with iodine-125 for low-risk disease demonstrated differences in biochemical failure rates when dose coverage fell below a defined D90 threshold. These findings reinforced the importance of delivered dose in achieving optimal outcomes.

Subsequent multi-institutional analyses comparing palladium-103 and iodine-125 across thousands of patients demonstrated durable biochemical control rates using strict prostate-specific antigen thresholds. Dr. Mirić discusses dose-deescalation research evaluating palladium monotherapy, in which randomized comparisons of 125 Gy versus 110 Gy showed similar long-term biochemical control with potential reductions in urinary toxicity.

He reviews additional monotherapy approaches, including high-dose-rate brachytherapy and stereotactic body radiation therapy. Evidence from prospective studies suggests that single-fraction high-dose-rate brachytherapy produces inferior outcomes compared with multi-fraction regimens. Longer fractionation schedules appear to improve biochemical control rates but may require multiple procedures.

For intermediate-risk disease, randomized trials such as RTOG 0232 indicate that high-quality brachytherapy monotherapy may eliminate the need for supplemental external beam radiation in many patients. In higher-risk disease, studies including ASCENDE-RT demonstrate that brachytherapy boost strategies can reduce biochemical failure compared with external beam radiation alone.

Despite excellent cancer control, Dr. Mirić emphasizes that most prostate cancer survivors ultimately die from causes unrelated to prostate cancer, particularly cardiovascular disease and other malignancies. He calls for greater emphasis on survivorship care, including cardiovascular risk management, lifestyle interventions, and comprehensive men’s health strategies.