Michael J. Zelefsky, MD, presented “Combining SBRT and Brachytherapy in Higher Risk Prostate Cancer” during the 24th Annual Southwest Prostate Cancer Symposium on April 12, 2019 in Scottsdale, Arizona.

How to cite: Zelefsky, Michael J.. “Combining SBRT and Brachytherapy in Higher Risk Prostate Cancer” April 12, 2019. Accessed Nov 2019. https://grandroundsinurology.com/combining-sbrt-and-brachytherapy-in-higher-risk-prostate-cancer/

Combining SBRT and Brachytherapy in Higher Risk Prostate Cancer – Summary:

Michael J. Zelefsky, MD, argues that combining stereotactic body radiation therapy (SBRT) with low-dose rate brachytherapy can help to reduce the morbidities of combined-modality radiotherapy. He also emphasizes the need to address the issue of toxicity with careful patient selection, treatment planning, and adherence to tight dose constraints.

Abstract: 

Combining external beam radiation therapy (EBRT) with brachytherapy, a form of combined-modality radiotherapy (CMRT), is the most potent local therapeutic intervention physicians have to address locally advanced prostate cancer. CMRT has superior tumor control outcomes compared to EBRT alone

Despite outstanding results, CMRT has not gained traction as a primary treatment due to toxicity concerns. Many practitioners would prefer to only recommend EBRT plus androgen deprivation therapy (ADT) as the standard regimen.

However, rather than avoiding CMRT, the medical community should address these morbidity concerns through meticulous care, better patient selection, improved dose planning with MRI visualization, the utilization of technology such as rectal spacers, and adherence to tight dose constraints. 

Other possible methods of reducing these morbidities that are under consideration include the use of SBRT with brachytherapy, as well as testosterone annihilation plus SBRT

Additionally, CMRT has the ability to provide local dose escalation to a dominant lesion, rather than treating the entire gland. Focusing radiation on the dominant intraprostatic lesion (DIL), which is the most common site of local recurrence, could enhance tumor control. Recent technological advances in diagnostic imaging and radiation techniques allow for the facilitation of dose escalation in these dominant nodules. 

About the Southwest Prostate Cancer Symposium

The Southwest Prostate Cancer Symposium (SPCS) is a multi-day conference that seeks to educate urologists, radiation oncologists, medical oncologists, and other healthcare professionals involved in the treatment of prostate cancer. The topics focus on current technical aspects of diagnosis and treatment of localized and advanced disease, particularly regarding imaging, technology, and training in the related devices. Dr. Zelefsky presented this lecture during the 24th SPCS in 2019. In 2020, the 25th SPCS will also offer training sessions involving imaging, scanning, and prostate cancer treatment-related devices on site. Please visit this page in order to register for future SPCS meetings.